HYPOPHYSIAL DYSTROPHY 311 



it affects in the same manner the occurrence of the bone-nuclei and of the epiphysial 

 closure, -while in pure eunuchoidism the epiphysial closure is indeed involved, 

 but this disturbance lasts until late in life. 



To the above-described manifestations is added, according to the process 

 that damages the hypophysis, a series of manifold symptoms. Most common 

 are tumor symptoms, such as tend to appear in tumors of the middle fossa of 

 the skull. Most frequent are heacfaches, that for the most part are not lo- 

 calized; also disturbances of vision (bilateral hemianopsia or simple amblyo- 

 pia and amaurosis, genuine atrophy, and not rarely choked disc). First 

 there appears bilateral hemianopsia for colors, and only later for white; in 

 quite rare cases there may occur a homonymous hemianopsia owing to de- 

 struction of the tract by a tumor (a case of O. Hirsch's) ; in addition vertigo, 

 insomnia, frequent yawning (little sleep at night however), apathy, finally 

 psychic disturbances, sometimes also nasal discharge of cerebrospinal fluid. 

 With these symptoms are associated paresis of the eye-muscles, disturbances 

 of smell, taste, and hearing, vomiting, manifestations of a hydrocephalus, 

 bilateral clonic twitching, eventually paresis of the extremities. Exophthal- 

 mus may also occur, owing to penetration of the tumor into the orbit (case 

 of Pechkranz) . 



According to the nature of the picture, the X-ray examinations show 

 widening of the introitus to the s"ella with destruction of the clmoid processes 

 and eventually with deepening of the sellar floor (especially in tumor of the 

 hypophysis), but in extrasellar processes sharpening of the clinoid processes, 

 and only later destruction of these (Erdheim and Schuller) , deepening of the 

 impressiones digitata? in youthful individuals, eventual enlargement of the 

 skull and essential thinning of its bony walls. 



Noticeable, finally, are certain alterations of the psyche, v. Frankl- 

 Hochwart emphasizes that in these patients there is a remarkable restlessness 

 and resignation, and that in spite of the existing headache they often show 

 a gay temperament. In youthful individuals, at all events, this gay tempera- 

 ment (case F., Observation XLIV, and the case of Sprinzet) contrasts mark- 

 edly with the stupidity and moroseness of hypothyroidism in childhood. 

 In many cases of hypophysial dystrophy there may, of course, also occur a 

 fairly appreciable degree of uninterestedness, which, however, may be much 

 benefited by operation (confer case Si., Observation XXXIV). Now and 

 then there develop also more or less pronounced psychoses. Finally it should 

 be mentioned that also hypophysoprivic dogs show characteristic psychic 

 alterations. 



The pathologico-anatomical findings that are found in this syndrome are 

 extremely manifold. First of all, there are tumors of the hypophysis itself; 

 a detailed summary of the tumors of the hypophysis without acromegaly 

 is found in the publications of v. Kollarits and of v . Frankl-Hochwart. 



v. Frankl-Hochwart has collected ninety-seven cases of tumors of the 



