HYPOPHYSIAL DYSTROPHY 313 



gland is of the size of an apple, rather hard, and extends under the sternum, as is seen on 

 examination of the X-ray plate. Circumference of the neck 44^ cm. Voice slightly 

 roughened. Chvostek I positive. Electric excitability normal. 



Blood-pressure (according to Gartner) go 



Blood count: Erythrocytes, 4,800,000 

 Hemoglobin (Sahli), 57 per cent. 

 Leucocytes, 15,000, of which: 

 Polymorphonuclear neutrophiles, 62 per cent. 

 Lymphocytes, 19 per cent. 

 Large mononuclears, 10 per cent. 

 Eosinophiles, 9 per cent. 



Pirquel's reaction negative. Patellar reflexes weak. Hyperesthesia of both lower 

 extremities. Nerve trunks slightly tender. Especial hyperesthesia of the soles of the 

 feet. No hairs in the axillae. No mustache hairs. Beard hairs almost entirely absent. 

 Hair on the body absent with the exception of the pubic hair that is still present somewhat 

 copiously. There are no hairs at all on the perineum. The entire body is extremely thin, 

 and there is a cushion of fat still indicated only on the mons Veneris. The penis is strikingly 

 small, prostate hardly palpable. Nipples quite stunted. 



X-ray examination of the skull showed considerable enlargement of the sella lurcica to 

 the size of a two-crown piece. Sellar introitus apparently intact. 



Alimentary glycosuria (200 gm. dextrose), negative. 



Sugar in blood, 0.081 per cent. 



Rapidly increasing cachexia, development of a pneumonia that led to an increase of 

 temperature. Kernig's symptom is positive, lumbar puncture negative. On July 5, 

 the blood count was: 



Erythrocytes, 3,300,000 



Hemoglobin (according to Sahli), 45 per cent. 



Leucocytes, 13,900, of which: 



Neutrophiles, 58 per cent. 



Lymphocytes and large mononuclears, 17 per cent. 



Eosinophiles, 25 per cent. 



On both sides the struma decreases very much in size, so that on July i the circumference 

 of the throat was only 39 cm. 



Death on July 23. 



Autopsy (Assistant Erdheim): Hazelnut- sized cyst of the hypophysis with marked 

 pressure atrophy of the pituitary parenchyma and dilatation of the sella turcica. The 

 peduncle of the hypophysis and the base of the skull unaltered. The operculum sellae 

 deeply retracted. Cerebral hernias with erosion of the vitreous table in the domains of 

 the posterior and middle cerebral fossae. But the convolutions are not flattened. Grow- 

 ing struma (Langhans) proceeding from the middle lobe of the thyroid gland with exten- 

 sive pressure atrophy of the thyroid parenchyma proper. The thymus small, rich in fat, 

 the suprarenal markedly atrophic, the atrophy affecting exclusively the cortex, the Medulla 

 remaining abundantly developed. Atrophy of the testicles, marked general marasmus, 

 marked senile atrophy of the upper and lower jaws without almost complete absence of 

 teeth. Lobular pneumonia, etc. 



The microscopical examination of the hypophysis in the sagittal direction, for which I 

 am indebted to Dr. Erdheim, shows the following: The hypophysis is taken up centrally 

 by a single-chambered, smooth-walled cyst, which is partly filled with a homogeneous 

 portion and partly with a shreddy portion. The cyst for the most part is not lined 

 with epithelium, there being present a single layer of epithelial cells for a short distance 



