HYPOPHYSIAL DYSTROPHY 319 



aches and an improvement in the visual power and manifestations that are 

 intelligible as the result of the release of pressure. In some cases are also 

 observed the occurrence of slight menstrual hemorrhages or of erections. 

 As far as I know, this improvement in the activity of the sexual glands is 

 only slight, and may also be explained by the release of the pressure from the 

 part of the hypophysis that is still capable of functionating. 



I must naturally leave open the question of the possibility that through 

 damaging of centers in the hypothalamic region similar disturbances may be 

 brought about in genital function, and that in the cases of diseases of the 

 mid-brain which lead to hypophysial dystrophy, without any essential patho- 

 logico-anatomical alterations of the hypophysis, the disturbance may per- 

 haps find its explanation in the fact and indeed even in such cases does the 

 position seem to me just as capable of being maintained in discussion as in 

 the cases mentioned above that through such processes the function of the 

 hypophysis is disturbed on account of the characteristic topographic rela- 

 tions, the more so because in such cases we tend to find also other symptoms 

 of hypophysial dystrophy, symptoms such as disturbance in growth, raising of 

 the limit of assimilation of carbohydrates, alterations of the blood picture, etc. 



Let us now consider the obesity. The obesity to be observed in cases of 

 hypophysial tumors without acromegaly shows in respect to the distribution 

 of fat full analogies with that which is seen in eunuchs arid eunuchoids. 

 (v. Noorden) . Especially important seems to me the circumstance that even 

 where there is no obesity proper the abnormal distribution of fat is always 

 indicated. This holds true almost always, even in markedly cachectic 

 emaciated individuals. Moreover, we hardly find this distribution of fat 

 expressed in typical manner unless there is present at least some degree of 

 insufficiency. Finally I would again point out that in the predominating 

 majority of the observations reported up to the present the beginning of the 

 disease occurred in youth. Among the cases that have developed the dis- 

 ease later are apparently those in which the abnormal distribution of fat is 

 indeed indicated, but in whom there is otherwise no obesity, but marked 

 emaciation rather. 



The loss of the function of the hypophysis hence seems to lead to obesity 

 only under certain conditions. Marked cachexia may prevent the occurrence 

 of the obesity, apart from the suggestion of the abnormal distribution of fat. 

 As example, I quote the above accurately reported Observation XLV, or 

 the case of Sokolojj in which a large gumma was found in the hypophysis. 

 For the most part this seems to be the case in sclerotic processes that involve 

 not only the hypophysis, but also other ductless glands. In multiple duct- 

 less glandular sclerosis, we come to recognize the rapidly developing cachexia 

 as an important symptom; here is found at most a suggestion of the abnormal 

 distribution of fat, or no obesity, even when the hypophysis is seriously in- 

 volved (see Chapter XI). 



