DYSTROPHIA ADIPOSOGENITALIS 867 



most serious of all local pressure symptoms associated with hypophyseal 

 disease. These lesions are usually bilateral. The most important lesion 

 is primary optic atrophy, in one-third of which choked disc precedes the 

 atrophy. In a series of 183 cases of hypophyseal tumors collected by 

 Walker and Gushing 148 showed disturbance of the visual field, 47 of 

 which manifested bitemporal hemianopsia, and the remaining blindness in 

 one eye. Total blindness in both eyes rarely occurs. Bitemporal hemian- 

 opsia, which has been considered quite characteristic of pituitary lesions, 

 occurred in about 32 per cent of cases with distorted visual fields. In 19 



O.KOL. N. J, U. S. A. 



(Dotted lines field for red.) 



Fig. 1. Mrs. K., age 46 (Jan. 8, 1920). complaining of quivering of the eyes for 

 not more than five years ; headaches rarely. 



1. Partial atrophy of both optic discs, more marked in right eye. 



2. Central vision with correcting glasses ( 1.0 Ds- 0.75 DC ax 90), R.E. 20/76; 

 L.E. 20/24. 



3. Marked nystagmus, chiefly vertical, slightly rotatory. 



4. Examination of the fields shows sharply divided bitemporal hemiopia passing 

 through point of fixation. 



5. The X-ray showed an enlarged sella with symptoms of hypopituitarism. 



6. Diagnosis: hypophyseal mass with hypopituitarism of the glandular portion. 



(Courtesy of Dr. Harry Friedenwald.) 



per cent there were no perimetric deviations noted. The homonymous de- 

 fects occur relatively infrequent as compared to the bitemporal. Bitemporal 

 hemianopsia may also appear as a symptom of primary disease of the 

 optic nerves, as a local manifestation of cerebral lues or as a symptom 

 of tabes. Early blindness is rare (Leber, Josephson, Henneberg), and 

 in the non-malignant and slowly-growing tumors of the hypophysis or 

 of the infundibulum the visual disturbances appear relatively later, some- 

 times not for years. 



The changes in the visual fields ordinarily progress slowly involving 

 primarily the color boundaries, beginning most frequently in one upper 

 temporal quadrant, which gradually develops into a more or less com- 

 plete temporal hemiachromatopsia. The color fields are always involved 

 before the form fields. 



At a certain stage of the process in the development of bitemporal 



