894 HAEVEY G. BECK 



seven (Neurath), ten (Bournier), and among others cites his own cases in 

 which growth ceased at eight and thirteen years of age respectively. 



Nervous and Menial Manifestations. Headache is one of the most 

 constant symptoms of pituitary disease. It is usually severe and intract- 

 able, occurring in paroxysms and described as being located between the 

 temples or deep behind the eyeballs. It is frequently associated with 

 other symptoms of intracranial pressure, such as vertigo, projectile vomit- 

 ing, and visual defects due to optic nerve lesions, such as optic atrophy 

 and choked disc. Hypophyseal tumors may cause local pressure upon 

 the optic chiasm and produce well marked eye symptoms of which bi- 

 temporal hemianopsia is the most important. Homonymous hemianopsia 

 also occurs. A tumor which extends beyond the margin of the sella may 

 involve the third cranial nerve, producing external strabismus, or the 

 sixth cranial nerve producing internal strabismus. 



The so-called uncinate attack (epileptiform seizures with gustatory 

 and olfactory aura) result from pressure on the uncinate gyrus. In the 

 early and milder forms of dystrophia adiposogenitalis mental symptoms 

 are not marked. In more advanced cases they may vary from a mild 

 psychosis to states of insanity. Drowsiness, stupor, and apathy are com- 

 mon symptoms. Patients are often languid, irritable, and lack self-con- 

 trol. Xeuromuscular pains, such as lumbago and sciatica, were observed 

 frequently in my series. There is diminished excitability of the vegetative 

 nervous system. 



The sella turcica is usually enlarged and deformed, if the lesion is due 

 to a tumor, and small and closed-in by the clinoid processes, if the lesion 

 is not due to a tumor. The former is usually associated with neighbor- 

 hood signs and symptoms. In the latter they are generally absent. This 

 subject in addition to others of equal importance will be considered more 

 fully elsewhere. 



Polydypsia and Polyuria are present in many of the cases. The 

 polyuria may be transitory or more or less permanent. When associated 

 with tumors in the neighborhood of the hypophysis, especially those in- 

 volving the chiasm and subthalamic region or with basilar syphilitic men- 

 ingitis, a true diabetes insipidus may develop. 



Vesical irritability is a common complaint, a symptom which has been 

 ascribed to weakness of the bladder musculature. Albuminuria has not 

 been observed in a single case in the writer's series. In the case reports, 

 as found in literature, reference is rarely made to the presence of albumin 

 in the urine. Sugar, however, does appear in the urine occasionally in 

 hypophyseal dystrophy. Seven cases presenting the picture of diabetes 

 mellitus are found in von Frankl-Hochwart's statistics. It is possible 

 that the few reported cases are mere coincidences of pancreatic diabetes. 

 If they are of hypophyseal origin, they can only be explained on the basis 

 of a functional heteroactivity of the gland : hyperactivity of the posterior 



