320 THE DISEASES OF THE HYPOPHYSIS 



If we assume, as does Aschner, in agreement with Erdheim's hypothesis, 

 that the higher grades of obesity only come about through the pressure of the 

 superiorly growing tumor on a center lying in the hypothalamic region, the 

 occurrence of these in cases in which the process is limited to the sella would 

 be unintelligible. We would therefore find obesity likewise in those cases of 

 acromegaly in which the tumor grows out of the sella and leads to marked 

 eye disturbance. In these diseases, however, obesity belongs to the rarities, 

 and is even then apparently not of a high grade. Finally, as is even of more 

 weight, we never find in typical acromegaly an indication of eunuchoid fat 

 distribution, such as we always find in the dystrophy. Hence it seems to me, 

 that the obesity depends entirely on the genital disturbance and to be a re- 

 sidual manifestation of the same. Under circumstances we also find in pure 

 eunuchoidism an obesity of quite the same type as in hypophysial dystrophy; 

 the same distribution of fat and in addition the same softness and delicacy of 

 the skin; here, however, there can be no question that there is no process in 

 the hypothalamic region. 



Also the remaining cardinal symptoms speak for the supposition that the 

 clinical picture depends on a loss or decrease of function of the hypophysial 

 apparatus. The reduction in the exchange of gases fits in well with the re- 

 sults of experimental physiology, as does also the reduction of the excitability 

 of the vegetative nerves observed in my cases, and also the sluggishness of carbo- 

 hydrate metabolism. The supposition of Aschner as to the genesis of glyco- 

 suria in acromegaly is made quite unlikely by the fact that then we would 

 have to expect glycosuria very much more frequently in intrasellar or 

 extrasellar tumors without acromegaly than in acromegaly, while as already 

 mentioned the carbohydrate metabolism shows in all cases the abnormal 

 sluggishness. The case of Link, with tumor of the hypophysis (without 

 acromegaly) and diabetes, does not mean anything. An occasional individ- 

 ual may have degeneration of the insular apparatus and diabetes and also a 

 tumor of the hypophysis. 



Finally the growth disturbance! On a careful review of the literature, I have 

 been able to ascertain that all cases that begin in youth are associated with a 

 disturbance of growth, so that in this respect there is an entire agreement 

 with experimental pathology. I cannot agree with the conjecture of Aschner 

 that true dwarfism depends on a lessening of the function of the hypophysial 

 apparatus (see Chapter XII). 



On taking into consideration all the facts and convictions set forth above 

 it is my opinion that to-day we are justified in the assertion that the disease 

 picture of hypophysial dystrophy depends on a loss or lessening of the function 

 of the hypophysial apparatus. 



Finally the question comes up for discussion as to which part of the 

 hypophysial dystrophy is to be ascribed to the involvement of the glandular 

 lobe of the hypophysis and which part to that of the nervous lobe. B. Fischer 



