318 THE DISEASES OF THE HYPOPHYSIS 



was formerly assumed to be the case, and which has recently again been up- 

 held by B. Fischer, Gushing and very recently also by Biedl. We find on the 

 contrary that the beginning of acromegaly the genital disturbance is exactly 

 the opposite from what it is in hypophysial dystrophy, and also varies from it 

 later on in the disease. In acromegaly is found at first even increase of the 

 generative function, at all events always a marked accentuation of the func- 

 tion of the interstitial glands or at least no signs of a disturbance. Apart 

 from rare exceptions, that are becoming even fewer, the condition lasts until 

 well in the course of the disease. On the contrary we find in hypophysial 

 dystrophy from the beginning, in addition to the disturbance in the function 

 of the generative glands, disturbances of the interstitial glands. This is the 

 more pronounced the younger the individual affected. Moreover, the cases 

 in which the disease begins in later life are very rare. In them the dis- 

 turbance of the generative function is more distinct than that of the interstitial 

 glands, indeed it appears as though the retrogression of the once fully devel- 

 oped secondary sexual characters only becomes more distinct when atrophic 

 processes in the other ductless glands, especially the suprarenal cortex, are 

 added, as happened in the case I reported (Observation XLV). Here indeed 

 may occur all transitions to multiple ductless glandular sclerosis with its pro- 

 nounced late eunuchoidism. Aschner mentions that the disturbances of the 

 function of the sexual glands in animals experimented on are found wholly 

 pronounced only when the extirpation of the hypophysis has been undertaken 

 in an animal that is still developing. It seems to me that this does not con- 

 stitute a contradiction to, but rather an agreement with, the experiences met 

 with in human pathology. 



Clinical experience further teaches us that in hypophysial dystrophy the 

 genital disturbances may develop fully even if the pathological process is 

 limited to the hypophysis and entirely intrasellar. I refer to the case of 

 Maranon or to Observation XLV. If for the existence of the genital disturb- 

 ance there was necessary a pressure on a center lying in the hypothalamic 

 region, therefore a forward growth of the tumor, in these cases the occurrence 

 of the genital disturbance would be as inexplicable as in animal experimenta- 

 tion after extirpation of the hypophysis. Also in many cases of acromegaly 

 in which the sellar introitus is dilated, in which growing out of the tumor 

 leads to visual disturbances, perhaps early, and in which there are manifesta- 

 tions of an increased brain pressure, we would then find genital disturbances 

 of the type of hypophysial dystrophy. From all this seems to me to be 

 elicited the fact that loss of function of the hypophysial function alone can 

 lead to gential disturbances of the type of hypophysial dystrophy, just as 

 conditions of hyperfunction of the hypophysis may lead to those of the acro- 

 megalic type. The results of the operative treatment of hypophysial dys- 

 trophy throughout as I already mentioned in 1908 do not speak against 

 this supposition. The most essential result consists in the relief of the head- 



