324 THE DISEASES OF THE HYPOPHYSIS 



the hypophysis, in which there was also a similar tumor of the thyroid 

 gland. We have also seen that in acromegaly, often manifestations of 

 hyperthyrosis occur, or, especially in the later stages, hyperthyrosis with 

 corresponding pathologico-anatomical alterations of the thyroid gland. 

 Moreover, we shall see later that in multiple ductless glandular sclerosis, 

 the sclerotic process affects almost regularly thyroid gland and hypophysis. 

 A slight degree of the thyroid gland insufficiency does not seem to be rare 

 also in hypophysial dystrophy at least, a myxedemoid puffiness of the face 

 may be observed, especially in the later stages. Finally, the hypophysis 

 may degenerate also in the later stages of Basedow's disease. I would sur- 

 mise this, because in such cases are found characteristic fat-deposits and 

 swellings of the skin that remind one of myxedema, while the hyperthyrosis 

 still continues and shows a great sensitiveness against thyroidin. 



All this points to the fact of an uncommonly intimate pathological corre- 

 lation between hypophysis and thyroid gland, that is well adapted for the 

 complication of clinical pictures. 



Differential Diagnosis. The first question to be decided in the matter of 

 differential diagnosis is as to whether an existing adiposo-genital dystrophy is 

 of hypophysial origin, or whether the individual is a eunuchoid; if the latter is 

 the case, of course all symptoms of brain pressure are absent, and the X-ray 

 plate shows a sella of normal size. But it should not be forgotten that also 

 in hypophysial dystrophy, the sellar alterations and the pressure symptoms 

 may be absent, if gummata, tubercles, or sclerotic processes cause a dis- 

 turbance of function of the hypophysis. Perhaps also in many cases the 

 examination of the respiratory metabolism might be used for purposes of dif- 

 ferential diagnosis. Marked reduction of it would probably only occur when 

 the case is one of hypophysial dystrophy. Of course, many more investiga- 

 tions in this direction are necessary. Probably the ossification conditions are 

 important from the standpoint of differential diagnosis. In primary genital 

 dystrophy certain epiphysial junctures remain open until high age, and there 

 occurs tallness and growth beyond the [age] growth limits of normal. In 

 severe cases of hypophysial dystrophy there occurs, on the contrary, an inhibi- 

 tion of development in the occurrence of the bone-nuclei and also dwarfism, 

 and the epiphysial junctures apparently remain open less long. 



The differential diagnosis from tumors of the pineal gland may be at- 

 tended with difficulty. In the cases of pineal gland tumor that begin in early 

 life the diagnosis is easy, as here is also found a premature development of 

 the genitalia. But even in youthful cases, the tumor of the pineal gland 

 may under circumstances restrict the function of the hypophysis, so that the 

 picture may become admixed with features of the hypophysial insufficiency 

 (see the case of Raymond and Claude, in the chapter on the epiphysis). 



Also the distinguishing of hypophysial dystrophy from multiple ductless 

 glandular sclerosis may present difficulties, as there exist cases that are 



