912 HAKVEY G. BECK 



this syndrome, after the operation, by injection or feeding anterior lobe 

 substance certainly furnishes sufficient evidence to warrant the admin- 

 istration of f anterior lobe substance in states of hypopituitarism. How- 

 ever, it is surprising, in view of these facts, that until quite recently few 

 cases of dystrophia adiposogenitalis successfully treated with anterior 

 lobe substance appeared in literature. This is probably due to the fact 

 that only the severe and more advanced cases, usually of neoplastic origin, 

 were formerly recognized, while the milder types, which are more suscep- 

 tible to treatment were almost invariably overlooked. 



Another difficulty formerly encountered was in grouping these cases. 

 Many of them present pluriglandular manifestations which result from 

 the reaction and interaction of the chain of ductless glands notably the 

 thyroid, sex glands, and adrenals. They frequently have a genital syn- 

 drome which may be primary or secondary, and symptoms referable to 

 thyroid and adrenal insufficiency. In the writer's series of forty-six 

 cases twenty-seven showed symptoms of varying degrees of hypothyroidism. 

 De Camargo makes the broad statement that there is no such thing in 

 pathology as monoglandular syndrome, for all endocrin syndromes are 

 pluriglandular with predominance of one gland. Consequently a com- 

 bination of the respective hormones, especially thyroid and pituitary, 

 should yield better results in this class of cases than either one given 

 singly. 



Among the earlier investigators, who claimed to have seen good 

 results follow the administration of hypophyseal substance in hypopitui- 

 tarism, are Gushing (b), Levy and Rothschild, Delille, and Falta(c). 



Pituitary extracts have been prepared in both dried and liquid form 

 from the whole gland, the pars anterior and the pars posterior. These 

 preparations are familiarly known by their trade names of which there 

 arc many. Bell (6) suggests as a convenient nomenclature pituitarin, hy- 

 pophysin, and infundibulin respectively. The selection of the preparation 

 used should depend upon the character of the symptoms. If there is 

 marked evidence of involvement of both lobes, the whole gland substance 

 is most suitable. If anterior lobe symptoms predominate, good results 

 are obtained by extract of the pars anterior. With marked asthenia, hypo- 

 tension, and high sugar tolerance the extract of the posterior lobe is in- 

 dicated, although these cases often respond well to thyroid medication. 

 The associated condition of diabetes insipidus can only be controlled by 

 the injection of infundibulin. 



As should be expected, not all cases respond favorably to treatment. 

 This applies especially to those in which there is a progressive lesion 

 of the pituitary gland or pressure from an adjacent tumor. Under these 

 circumstances pressure symptoms can best be relieved by surgical meas- 

 ures (decompression, extirpation) although the deficiency syndromes are 

 frequently benefited, at least temporarily, by organotherapy. 



