DYSTROPHIA ADIPOSOGENITALIS 869 



B. DISTURBANCES OF THE OCULAR MUSCLES 



1. Oculomotor paralysis 20 % II % 



2. Abducens paralysis 6 " 1.9 " 



3. Ophthalmoplegia 3.4 " 1.5 " 



4. Nystagmus 2 " 5.8 " 



Headaches. Among the initial symptoms of pituitary growth are 

 the periodical headaches, which especially occupy the frontal and temporal 

 regions, and may even extend to the suborbital and to one or the other 

 eyeball (Rosenthal 1879). Headache in some form occurred almost in- 

 variably as a symptom in my series of cases. It is often the most annoy- 

 ing symptom. The significance of cephalic pains occurring in hypophyseal 

 tumor was especially emphasized by Cushing(fr). He differentiated head- 

 aches originating in a hyperplast.ic pituitary gland from those due to in- 

 tracranial tension. The former he attributed to distention of the glandu- 

 lar envelope because relief of headache immediately followed the split- 

 ting of a tense capsule of the gland. 



Par dee, who made a careful study of the subject of pituitary head- 

 aches, considered that they constitute one of the early symptoms of pitu- 

 itary disease. Their characteristic features are their location, their dura- 

 tion and persistence, and their relief under specific medication. 



The location of the headache is variously described as bitemporal, in- 

 tratemporal or deep frontal. The patient feels as if it were situated be- 

 hind the eyeballs, and in endeavoring to locate it usually places the finger 

 on either temple. Firm pressure over the temples may elicit tenderness. 



There is a feeling of tension of the eyeballs and a sensation of pres- 

 sure, distention or bursting ache in the intratemporal area. The head- 

 ache is usually continuous and lasts from one-half hour to several days 

 menstrual headaches frequently take on this form. Mental strain, ex- 

 citement and errors in diet, especially an excess of sugar, are considered 

 predisposing factors; vomiting which occurs occasionally affords relief. 

 These headaches occur in both conditions of hyperfunction and hypo- 

 function of the pituitary gland. Timme(a) in his description of a new 

 pluriglandular compensatory syndrome confirms Cushing's and Pardee's 

 view as to the pituitary origin and the location of the headache. 



Alterations in the Sella Turcica 



Formerly a diagnosis of pituitary diseases was more or less presump- 

 tive unless rontgenographic studies revealed some anatomical alteration 

 in the size, shape, and general outline of the sella turcica. This, of course, 

 was due to the fact that the clinical syndromes associated with the dis- 

 turbance of the various functions of the gland were not as well defined 

 and as thoroughly established. It is now well known that even marked 



