906 HAKVEY G. BECK 



roid and adrenals is common knowledge. That of chronic infec- 

 tions is, perhaps, not so well understood, although they tend to glandular 

 degeneration with sclerosis, which should lead to hypofunction with its 

 concomitant syndromes. Chronic infections have been recognized as a 

 factor in thyroid deficiency. They occurred in seventy-eight out of one 

 hundred cases studied by the writer. From an analysis of forty-six cases 

 of hypophyseal dystrophy it appears that chronic infections play even a 

 more conspicuous role in pituitary deficiency. Forty-two of the cases 

 were associated with chronic infectious processes. Chronic appendicitis 

 and cholecystitis occurred in twenty-two cases, in three of which both 

 conditions existed. Chronic tonsillitis occurred in twenty cases and al- 

 veolar infection in thirteen. A history of malaria was recorded in four 

 cases. The incidence of these infections certainly suggest more than a 

 casual relation to hypopituitarism. The acute infections which occurred 

 in the series include typhoid, grippe, pneumonia, rheumatic fever, men- 

 ingitis, etc. 



Attention has been called by Massalongo and Piazza (1914) to post- 

 infectious dystrophia adiposogenitalis, reporting an interesting case fol- 

 lowing a severe pneumonia and citing two cases following typhoid, in 

 which degeneration or sclerosis of the gland was found. 



Cushing(6) noted the incidence of acute infectious processes in at least 

 seven of his cases in most of which symptoms of primary hyperpituitarism 

 were exhibited. A case of acute suppurative hypophysitis was recently 

 reported by Boggs and Winternitz. 



Guerrini found liistological changes in the pituitary gland as a result 

 of a reaction to acute and chronic intoxications, e. g. pilocarpin, ichthyo- 

 toxin, diphtheria toxin, and endogenous toxin. These effects are quite 

 similar to those produced upon the thyroid by various sorts of intoxication 

 which have been reported by Roger and Gamier, de Quervaine and Mar- 

 tini. 



New Growth 



For our first description of an associated obesity with an hypophyseal 

 tumor credit must be given to Mohr (1840). However, it was not until 

 about sixty years later that definite clinical syndromes were recognized 

 as the result of sucb tumors. Since then hundreds of cases of new growth 

 of various kinds have been reported. 



The simplest form of growth is probably a diffuse hyperplasia arising 

 from a functional overgrowth, such as occurs in the advanced form after 

 multiple pregnancies (Ewing). These may regress but some probably 

 pass into a malignant form of adenocarcinoma. The condition of hyper- 

 plasia, like in the thyroid, is often associated with adenoma; unquestion- 

 ably many cases regarded as tumors are simple hyperplasia. 



