786 J. P. SIMONDS 



anterior lobe without the formation of gummas, and with only slight 

 proliferate changes in the connective tissue. 



Few or no clinical data are given in the records of cases of congenital 

 syphilis of the hypophysis. With few exceptions the lesions have been 

 studied in the hypophyses of infants that were still-born or who died & 

 few hours or days after birth. Chiari's patient was 9 years old, and 

 showed a gumma of the anterior lobe. In my case spirochetes were pres- 

 ent in great numbers in the anterior lobe, fewer in the neurohypophysis. 



Tuberculosis of the Hypophysis. Tuberculous infection of the hy- 

 pophysis is not uncommonly associated with chronic tuberculosis of the 

 lungs, and is quite common in general miliary tuberculosis. The lesion 

 appears either as a conglomerate tubercle or as one or more miliary tuber- 

 cles. I have found records of 28 cases of tuberculosis of the hypophysis. 

 Of these 10 were miliary in type ( Lancer eaux (a), Lucien and Parsitot, 

 Simmonds(c?) (4 cases), and Schmidtmann (4 cases) ; and 18 were con- 

 glomerate tubercles (Beck, Boyce and Beadles (&), Hiitor, Haushalter and 

 Lucien, Cushing(a), Sommer, Heidekamp, Glinski, Zenoni, Bland-Sutton, 

 v. Hann, Froboese, Schmidt (c), Valenta, each one case; and Schmidtmann 

 and Schmorl, each 2 cases). In 3 additional instances (Simmonds (d), and 

 v. Hann) a scar was found in the neurohypophysis of tuberculous indi- 

 viduals, and the authors considered them to be the result of a healed 

 tuberculous process. In two other cases Schmidtmann observed miliary 

 tubercles in the capsule of the anterior lobe in patients with tuberculous 

 meningitis. 



Conglomerate tubercles commonly affect the anterior lobe, sometimes 

 the entire gland. The hypophysis which is the seat of such a lesion is 

 usually enlarged, is adherent to the sella, the capsule is thickened, and 

 the whole gland is firmer than normal. The amount of accompanying 

 fibrosis varies. Occasionally a part of the anterior lobe is composed of 

 connective tissue so dense as to be of cartilaginous consistency, as in the 

 case of Boyce and Beadles (5). On surfaces made by sectioning the central 

 part of the tuberculous portion is caseous; the peripheral part, fibrous. 

 Microscopically the appearance is that of a conglomerate tubercle in other 

 parts of the body. Giant cells are usually fairly numerous. 



Miliary tubercles are more frequently found in the posterior lobe. 

 They are often not visible even on very careful macroscopic examination. 

 Microscopically they do not differ from similar lesions in other organs. 



Etiologically, tuberculosis of the hypophysis may be classified as (a) 

 metastatic, and (b) as extension to the hypophysis from adjacent struc- 

 tures. The latter form is rare and usually results from involvement of 

 the hypophysis from a carious process in one of the bones of the base of the 

 skull, especially of the body of the sphenoid bone, as in the cases of Sommer 

 and Heidekamp. The metastatic form is usually, but not always, miliary 

 in type. Hillary tubercles of the hypophysis are frequently associated 



