774 J. P. SIMONDS 



and Glinski. They are usually anemic infarcts; but Merkel and 

 Berblinger(c) have each reported instances of hemorrhagic infarcts of the 

 hypophysis. In both of these cases, the infarction was due to thrombosis 

 of a vein and not to an embolus in an artery. 



In a detailed study of embolic processes in the hypophysis Simmonds(^) 

 reported 4 cases of mycotic emboli in the neurohypophysis, with small 

 localized abscesses; 2 cases of mycotic emboli in the anterior lobe; and 4 

 cases of typical anemic infarcts of the anterior lobe. Of these 10 hypophy- 

 ses, 9 were from persons dead from streptococcic or staphylococcic 

 septicemia, and one from a woman who died 6 days postpartum from de- 

 compensation of the heart. Septicemia, especially puerperal sepsis, and 

 verrucose endocarditis appear to be the chief etiologic factors in the 

 causation of infarcts of the hypophysis. Areas of necrosis in the anterior 

 lobe in cases of eclampsia have been described by Merkel and Schmorl; 

 whether these were due to embolic processes was not stated. 



Upon gross examination of the hypophysis, infarcts may not be visible, 

 or are easily overlooked. In microscopic sections, infarcts appear as 

 sharply defined areas, more or less wedge-shaped, in which the nuclei do 

 not stain and the cytoplasm of the cells takes the eosin stain. The cell 

 outlines are still visible as in coagulation necrosis elsewhere. At the 

 periphery of the necrotic area there is frequently a zone of leukocytic 

 infiltration, especially in those cases in which the embolus contained cocci. 

 No mention is made of a zone of hyperemia surrounding an infaret of the 

 hypophysis, such as is seen about an infarct of the kidney. 



If the patient survives the pathological condition which is responsible 

 for the infarct of the hypophysis, the area of necrosis undergoes simul- 

 taneous resorption and organization by the ingrowth of connective tissue, 

 in the same manner as in infarcts of any other organ. The final result 

 is a wedge-shaped scar at the site of the infarct. Such scars in the hy- 

 pophysis are usually accompanied by scars ("ancient infarcts") in the 

 kidneys and spleen. 



If the infarct is relatively large, there may be destruction of such an 

 amount of the hypophysis as to induce disturbances due to diminished 

 function of the anterior lobe. The cases of Merkel, or Fraenkel(fr), and 

 four of Simmonds'(^) cases were women who, after the birth of their last 

 child, from 9 to 11 years before death, suffered from puerperal sepsis. 

 This was followed by cessation of menstruation and by progressive weak- 

 ness and emaciation. Simmonds'(.g) (n) fifth patient was a dwarf, with 

 hypoplasia-of the genitals and lack of secondary sex characteristics. In all 

 seven of these cases, autopsy revealed an almost complete replacement of 

 the anterior lobe of the hypophysis by dense fibrous tissue, without other 

 lesions in the other organs of the body to account for the clinical manifesta- 

 tions, except a carcinoma of the stomach in one of Simmonds' patients. 



