770 J. P. SIMOKDS 



orrhage into the hypophysis in traumas of the skull/' In my own series 

 of cases, which includes a number of cases of fracture of the base of the 

 skull, I have observed hemorrhage into the capsule of the hypophysis, 

 but not into the substance of the gland itself. The clinical features of 

 cases of hypopituitarism following injury to the skull have been reported 

 by Madelung, Cushing(&) and Stolper. The latter's patient ultimately 

 came to autopsy which revealed a struma of the hypophysis. Bleibtreu has 

 recorded a case in which gigantism and acromegaly developed after a severe 

 trauma to the head. Four years later, at autopsy the sella turcica was 

 found occupied by a mass of mature connective tissue with a few minute 

 remains of the anterior lobe. 



LeCount and Apfelbach have shown that linear fractures of the base 

 of the skull follow fairly definite lines. They do not mention the relative 

 frequency with which these lines involve the sella turcica. In 34 cases of 

 fracture of the base of the skull in which I have accurate measurements 

 and charts, the line of breaking crossed the sella 5 times. In these cases 

 the fractures either ran almost in the coronal plane, passing between the* 

 spheno-maxillary fissure in front and the foramen ovale and foramen jug- 

 ularis behind, and thence transversely across the sella; or, more rarely, 

 the line of fracture extended along the sagittal plane and crossed the sella 

 in an antero-posterior direction. The anatomical relations of the sella 

 turcica and their influence upon the course of fractures of the base of the 

 skull may account for the relative infrequency of injury to the hypophysis 

 in traumas of the head. 



Injuries of the hypophysis due to intracranial pressure. The effect of 

 pressure by tumors and internal hydrocephalus upon the hypophysis has 

 been referred to. More important than the anatomical malformations 

 which they induce is the effect upon the function of the gland. Cushing(&) 

 and Stumpf (b) are of the opinion that at least a part of the secretion of the 

 hypophysis is absorbed through the infundibulum. Pressure which inter- 

 rupts these channels of absorption may be the etiologic factor in some cases 

 of hypopituitarism. 



Changes in the Hypophysis Incident to Age 



Changes that are more or less physiological occur in the hypophysis 

 with advancing age. In the first place, its size and weight diminish. 

 According to Simmonds'(e) figures, based upon the weights of 800 hypoph- 

 yses, the weight increases up to the age of 60, and then gradually 

 diminishes. Thorn found the average size for both sexes to be greatest 

 between 40 and 50. After that age the hypophysis became smaller, the 

 diminution affecting the vertical diameter more than the transverse and 

 sagittal diameters. This is due largely to an increase of fibrous tissue in 



