. 628 LEWELLYS F. BARKEE 



Again, associated disease of the pituitary gland may be responsiblefor 

 some of the psychoses of tetany. This possibility has been suggested by 

 Barrett (1920), who observed two patients who exhibited a tetany 

 psychosis during life and at autopsy were found to have cysts in the 

 pituitary gland. 



Furthermore, the effects of extracts of the pituitary gland in con- 

 trolling tetany indicate a cooperative action between the hypophysis and 

 the parathyroid glands. Ott and Scott (a) (1908) showed that in feline 

 tetany, the pituitary gland, given in distilled water subcutaneously, had 

 an effect at least equal to that of calcium salts in relieving the tetany that 

 followed complete parathyroidectomy. Pal of Vienna (1909) gave pitui- 

 trin to a boy suffering from severe tetany, and reported that the syndrome 

 disappeared in 24 hours. 



Ott and Scott found, however, that pituitrin in feline tetany had only 

 a fugitive action. They asserted, nevertheless, that neither pituitrin nor 

 infundibular extract had as lasting effects as the whole gland was capable 

 of exerting. 



The hypertrophy of the pars intermedia of the hypophysis that fol- 

 lows extirpation of the parathyroids also speaks in favor of a cooperative 

 relation between these two organs. Thus, Thompson found that the histo- 

 logical changes in the pars intermedia following parathyroidectomy are 

 almost identical with those following thyroidectomy, the identity extend- 

 ing even to the marked accumulation of colloid. The evidence, therefore, 

 favors the view that the hypophysis cerebri can, on demand, compensate 

 to a certain extent for the loss of parathyroid function. 



Chromaffin System 



Some of the symptoms in the acute stage of tetany suggest that, in this 

 syndrome, there is [in increased activity of the chromaffin system. Certain 

 of the phenomena met with in animal experimentation, too, point to the 

 tendency to hyperchromaffinism in hypoparathyroidism. Guleke found 

 that the tetany spasms disappeared in parathyrodectomized animals when he 

 extirpated also the suprarenal glands. Even ligature of the suprarenal 

 veins would temporarily cause the attacks of tetany to disappear, though, 

 as soon as the circulation in the suprarenals became reestablished., the at- 

 tacks of tetany recurred. These experiments of Guleke are suggestive of 

 an antagonism between the parathyroids and the snprarenals. 



Some experiments made by Eppinger, Falta and Kiidinger on tetany 

 animals suggest that, the secretion of the parathyroids inhibits the sympa- 

 thetic nerves, whereas that of the chromaffin system excites them. Other 

 experiments by Falta and Kalin have convinced these authors that a hyper- 

 excitability of the sympathetic nerve endings appears after parathyroidec- 

 tomy, so that the injection of epinephrin causes a primary vasodilatation. 



