DYSTROPHIA ADIPOSOGENITALIS 



873 



thickenings are probably due to osseous overgrowth, a feature of acromegaly 

 and gigantism. In the second variety there is thinning with perforations 

 of the sellar floor as well as of the dorsum, which is caused by bone ab- 

 sorption from pressure atrophy. The bony capsule may become too thin 

 to cast a very definite shadow. The condition occurs in advanced hypo- 

 pituitarism. In the early cases there may only be a, simple spherical dis- 

 tention. In the third variety the dorsum is almost completely absorbed, 

 the floor pushed downward and the bony landmarks, with the usual ex- 

 ception of the anterior clinoid processes, destroyed. 



Fig. 6. Large, open sella. Case of acromegaly and gigantism with secondary 

 hypopituitarism. Absorption of the dorsum and posterior clinoid process. (Rontgeno- 

 gram by Dr. John Evans.) 



To another important group, to which Cushing(&) called attention be- 

 long the abnormally small sellaB which accompany the primary glandular 

 hypoplasia of the young ; a condition frequently associated with dystrophia 

 adiposogenitalis and infantilism. 



.Some interesting radiographic studies of the sella turcica in its 

 relation to epilepsy and hypopituitarism have recently been made by. 

 Johnston. In a series of more than 100 cases of epilepsy studied he found 

 alterations in the sella in a certain group which occurred between the ages 

 of 15 and 35 with an uneventual history. "The changes consisted for the 

 most part in an overgrowth of the anterior and especially the posterior 

 clinoidal .processes, which in addition to an increase in area and length 

 were slowly folded over and down upon the pituitary gland enclosing it 

 within a bony basket.'' In some cases the fossa was completely roofed over 

 and the anterior and posterior clinoidal processes have even overlapped, and 



