314 THE DISEASES OF THE HYPOPHYSIS 



only. The tissue surrounding the cyst is J mm. thick and constitutes the markedly 

 pressure atrophied, strongly fibrous, glandular tissue of the hypophysis. This is bounded 

 externally by the fibrous capsule of the hypophysis. 



The microscopical examination of a piece of the thyroid gland showed a well-limited 

 benign epithelial tumor with numerous cavities filled with colloid, that are separated from 

 each other by septa that are purely epithelial. 



In this case there is surely a marked retrenchment of function of the 

 hypophysis of ten years' standing with a gradual increasing cachexia. The 

 disease was ushered in with an unknown infectious process. Perhaps this 

 also affected the hypophysis and gave occasion for the cyst formation. At 

 all events we find since that time a disturbance of the generative function, a 

 gradual partial retrogression of the secondary sexual characters, slight 

 atrophy of the accessory genital apparatus, especially the prostate. Perhaps 

 the marked atrophy of the suprarenal cortex plays a part in the retrogression 

 of the genitals and of the secondary sexual characters. 



Worthy of mention in this case is also the uncommonly rapid diminution 

 of the struma. At the beginning this was so hard that originally we thought 

 of a malignant process. 



Much cited is the case of Madelung. This concerned a nine-year-old girl. 

 At the age of six years, a shot injury from a Flobert gun. The girl has re- 

 mained behind in mental development, is very quiet. Considerable adiposity 

 which first developed after the injury (at the time the patient remained in 

 bed for five months) . The shot had penetrated the sella turcica via the left 

 eye; there was a slight dragging of the left leg and weakness of the left 

 arm. 



Besides these tumors originating from the hypophysis there are numerous 

 processes in the neighborhood of the hypophysis in which such cases of 

 dystrophia adiposo-genitalis are found. To these belong tumors that pro- 

 ceed from the brain membranes or the bones, or brain tumors. All possible 

 brain processes can lead to genital disturbances and adiposity, in so far as they 

 apparently call forth an increase of pressure in the third ventricle. Already 

 in 1855, Fr. Konig reported a case that seems to me to belong in this category. 

 It was that of an eighteen-year-old girl with undeveloped genitalia; she 

 had never menstruated. The visual power was disturbed. The head was 

 very large. Here was found a hydrops of all ventricles and atrophy of 

 the optic nerves; in the cerebellum, on the left, an echinococcus. This case, 

 on account of the deficient ossification of the pelvis was considered by A. 

 Paltauf one of the true dwarfism. For the first exact description of such 

 cases we have to thank E. M tiller; but Axenfeld, already in 1903, had pointed 

 out that tumors at the base of the brain may produce permanent amenorrhea 

 even at the beginning of the disease. In many of E. Mutter's cases there 

 developed a pronounced obesity. There was observed in the two autopsied 

 cases a tumor of the cerebellum, and a tumor of the occipital lobe respect- 



