DYSTROPHIA ADIPOSOGENITALIS 895 



lobe and hypoactivity of the anterior lobe. Such a condition might pos- 

 sibly occur during the transitional stage of hyperpituitarism into a sec- 

 ondary hypopituitarism or a state of dyspituitarism. The chief gastro- 

 intestinal symptoms are vomiting, projectile in character due to intra- 

 cranial pressure, and constipation due probably to lack of stimulation of 

 the involuntary muscular fibers of the intestines from posterior lobe de- 

 ficiency. 



Metabolism. The carbohydrate tolerance is increased in dystrophia 

 adiposogenitalis. This feature, according to Goetsch, Gushing, Jacobson, 

 is due to posterior lobe deficiency and is of considerable diagnostic im- 

 portance. In some cases the tolerance is almost unlimited, exceeding an 

 amount beyond the capacity of the stomach to take dextrose. It is not 

 unusual to find an assimilation of 300 grams dextrose or more. An actual 

 hypoglycemia may be present. According to Gushing both the increased 

 sugar tolerance and low blood sugar content can be corrected by injec- 

 tion of posterior lobe extract. Other evidence of metabolic disturbances 

 are the diminished carbon dioxid exchange (Benedict & Homans), reduc- 

 tion of oxygen consumption, lowered basal metabolism rate (Plummer), 

 and falling off in the nitrogen balance (Ashner(a)). The temperature is 

 subnormal; the pulse and respiration rate are diminished, and the blood 

 pressure is lowered. The temperature anomaly has been attributed to 

 deficiency of the anterior lobe and can be experimentally produced in 

 animals by partial removal of this lobe. Moreover, the injection of 

 anterior lobe extract will temporarily restore the subnormal temperature 

 (Thermic reaction Gushing). The abnormally low blood pressure, which 

 may fall to 100 or below, is due to lack of the pressor substance, which is 

 a normal constituent of the hypophyseal secretion. Hypotension, there- 

 fore, proves to be a common manifestation of hypopituitary states. In 

 exceptional cases with pluriglandular syndromes, in which the low blood 

 pressure is associated with asthenia and pigmentation, a secondary hypo- 

 adrenia may be a contributing factor. 



The blood presents a fairly constant picture in hypophyseal dystrophy. 

 While there is only a slight reduction of erythrocytes there is an ap- 

 preciable reduction of hemoglobin. The leucocyte count is usually below 

 the normal. The neutrophilic cells are relatively diminished, whereas 

 the mononuclears, and especially the lymphocytes, are not only relatively 

 but also absolutely increased. Many cases show a tendency to eosinophilia. 

 The mononucleosis and poverty of hemoglobin resemble that of myxedema. 



