296 



THE DISEASES OF THE HYPOPHYSIS 



is trrv riih in fat. Tlic penis is small, and on both sides the very small testicles remain in the 

 inguinal canal. 



The strabismus remains unaltered. The examination of the fundus shows on both sides 

 temporal paling of the papillcc. Perimeter normal. 



X-ray examination that had been made even before the patient's entrance into the 

 clinic shows entirely normal relations of the sella turcica. Examination of the hand-skeleton 

 shows that the epiphysial junctures and the rudiments of the hand-skeleton correspond 

 fully to the age. The patellar reflexes are lively, but with the exception of the nervous 

 status there is nothing else especial. 



Alimentary glycosuria (100 gm. D) negative. 



The amounts of urine vary between 4000 cm. and 6700 cm. The specific gravity is 

 1002-1003. 



During the stay at the clinic an attack of headache and vomiting occurred such as 

 is already described. This lasted for two and one-half days, the vomiting was uncontrol- 

 lable. Ingestion of food during this time nil. Ingestion of fluid very slight, only 1600 



cm., or 500 cm., or 1050 cm. The specific 

 gravity (of the urine) rose to 1013. The boy 

 during this time lost 3 kg., falling from 37^ 

 kg. to 34^ kg. 



The patient died a half-year after his en- 

 trance into the clinic. 



Summary. When the patient came into 

 the clinic, he showed the entire picture of dys- 

 trophia adiposo-genitalis. As X-ray exami- 

 nation shows the sella turcica to be normal, 

 it may well be assumed that a tumor pressed 

 on the hypophysial peduncle from above. 

 Also the diabetes insipidus fits into the pic- 

 ture, also the undoubted temporal paling of 

 the papillae, which had not as yet led to a 

 demonstrable hemianopsia. It is further 

 noteworthy that the concentrating power of 

 rfie kidneys was still present under certain 

 circumstances. 



FIG. 56. Genitalia of Observation 

 XXXVII. 



Very noticeable is also the statement of Strauss as to cases of diabetes 

 insipidus combined with corpulency of the hypophysial type, with lack of 

 pubic and axillary hair and with hypoplasia of the genitals. In many 

 such cases we are perhaps dealing with developing tumors of the vicinity 

 of the hypophysis, even though there are as yet no other signs of brain 

 tumor. 



As an example of this type, I cite the following case: 



Observation XXXVIII. S. K., twenty-one years old. Entered the clinic July 12, 

 1912. Mother of the patient was corpulent, and died of brain tumor. The patient's 

 corpulency began in the thirteenth year of life, together with increased sensation of thirst, 

 the patient sometimes drinking 5 liters of water a day. Corresponding polyuria. This 

 has continued since that time, and only during the last three years has it become somewhat 

 slighter. For years violent headaches, which of late have been increasing in intensity and 

 frequency. The patient has not as yet had sexual intercourse, although according to his 



