PATHOLOGICAL ANATOMY AND HISTOLOGY 775 



The lesion of the hypophysis in each -instance was believed to be the 

 result of an old embolic process occurring in the women as an accompani- 

 ment of puerperal sepsis, and in the dwarf, during the very early days 

 of life. 



From these cases it appears probable that a fairly well denned train of 

 results follows infarction of a considerable part of the anterior lobe of 

 the hypophysis. In adults there develops a progressive cachexia ; loss of 

 teeth, and of scalp, axillary and pubic hair; and atrophy of the genital 

 organs. If the embolism and infarction occur in the early days of life, 

 dwarfism and hypoplasia of the genitalia and failure to develop the 

 secondary sex characteristics result. 



Necrosis and Calcification 



Necrosis may occur in the hypophysis as a result of infarction ; or of 

 trauma ; or of infections of the gland itself, especially the infection granu- 

 lomas; or of the effects of toxic substances. It may take the form of 

 coagulation necrosis, as in infarction and in infection granulomas; or 

 liquefaction necrosis, as in acute suppurative inflammation. Coagulation 

 necrosis is usually anemic in type ; more rarely it *is accompanied by 

 hemorrhage into the necrotic area as in the cases of Berbliriger(c) and of 

 Merkel. Gierke(fr) states that arteriosclerosis and syphilitic arteritis can 

 cause ischemic necrosis of the hypophysis. Schilder found a small area 

 of necrosis in the anterior lobe in which the lumen of the vessels was much 

 narrowed by deposits of amyloid. 



Necrosis of toxic origin is less well understood. Boehncke and Koch, 

 and Creutzfeld and Koch observed in the pars intermedia of the hypophy- 

 sis of children dead from diphtheria, nuclear changes characteristic of 

 necrosis, namely, margination of the chromatin, pyknosis, karyorrhexis 

 and karyolysis. Similar changes were found in the hypophyses of guinea 

 pigs which had succumbed to subcutaneous injections of diphtheria bacilli. 

 Schmorl has observed similar necrotic processes in diphtheria. 



Necrosis of the hypophysis occurs occasionally in eclampsia. Schmorl 

 found small areas of necrosis in two cases of this disease. Berblinger(c) 

 has described an almost total necrosis of the hypophysis in a case of eclamp- 

 sia. These changes in the pituitary body appear to resemble those found 

 in the liver in this disease. Whether they are due to the direct action of 

 some toxin, or to a thrombosis of the capillaries, as shown by Ewing in 

 the case of the liver, cannot now be stated. Necrosis of the hypophysis in 

 eclampsia is probably not common, for, as pointed out by Schmorl, the 

 lesion is not mentioned by Erdheim and Stumme in their study of a 

 large series of cases. 



