44 ENDOCRINE GLANDS 



lished. It seems as if this very dangerous intervention, 

 which is advised in acromegalia and patients suffering from 

 adiposo genitalis, is only indicated when, to the symptoms 

 of pituitary disturbance, are added serious evidences of 

 hypertension (headache, alteration of vision), and when 

 the X-ray also shows a marked enlargement of the sella 

 tursica. The removal of the pituitary is never complete; 

 it is necessarily a partial operation and is purely palliative. 

 It seems as if in certain cases all that is done is to decom- 

 press the affected region. The recently published obser- 

 vations of Lecene and Morax verify this hypothesis, as by 

 causing a falling down of the deep wall of the sphenoidal 

 sinus, that is, the floor of the sella tursica, without touch- 

 ing the pituitary, Lecene was able to cause the disappear 

 ance of an adiposo genitalis syndrome, associated with 

 marked signs of hypertension, notably ocular disturbances 

 with changes in the disks, which were also improved by 

 the operation. A simple decompression has occasionally 

 given similar results. Pituitary surgery, therefore, is still 

 a method only to be used exceptionally, and aims more to 

 relieve hypertension than the pituitary lesion. However, 

 the results of decompression of the sella tursica, as per- 

 formed by Gushing and Lecene, show that this method 

 might be used in certain cases. 



However limited at present is the surgery of the endo- 

 crines, it is indicated in removable tumors, (certain thy- 

 roid tumors for instance) or to modify the consequences of 

 certain neoplasms which, as in the case of the pituitary, 

 cause secondary symptoms by direct pressure or by hyper- 

 tension. It cannot be said, however, that endocrine 

 surgery is a method we can hope very much from in the 

 future, since it can only act in tumors and their conse- 

 quences. It cannot remedy a glandular deficiency, the 

 usual result of an endocrine lesion. 



