DYSTROPHIA ADIPOSOGENITALIS 



923 



Radium has been used by Douglas Quick in three cases of hypophyseal 

 tumors but apparently it has no advantage over X-ray. 



The field of radiotherapy in pituitary disease is too new and the 

 cases reported are too inadequate to draw any very definite conclusions. 

 However, indications are that it is undoubtedly of value in selected cases of 

 hypophyseal tumors with hyperpituitary symptoms and early states of 

 secondary hypopituitarism or in dyspituitarism with pressure symptoms. 

 The most striking effect is upon the visual fields which have frequently 

 been benefited and in several instances slowly restored to normal. The 

 headache, vertigo and vomiting are often promptly relieved ; the adiposis 

 and genital functions have also been favorably influenced. For a de- 

 scription of the technic employed in radiotherapy of pituitary tumors 

 reference should be made to Loeb's article. 



General Measures. These are supplementary to organotherapy and 

 include diet, rest, exercise, massage, hydrotherapy, electrotherapy, etc. 

 They are valuable adjuncts in combating obesity, nervous and mental 

 states, cardiovascular disturbance, and asthenia. 



The restriction of carbohydrates and fats helps to reduce the weight of 

 the patient, which is desirable in many instances. However, without re- 

 course to glandular therapy the normal body configuration is not restored, 

 and the results are not permanent. Systematic exercise and massage 

 exert a favorable influence on the fat dystrophy and strengthen the muscles 

 which lack tonicity. 



Patients in whom the condition of dystrophia adiposogenitalis existed 

 for a long period generally present severe nervous symptoms frequently 

 mental disturbance, marked asthenia, slow pulse, low blood pressure, sub- 

 normal temperature, and increased sugar tolerance. In such cases the 

 best results are obtained by combining organotherapy with a rest cure, 

 in which stress is placed on diet, massage, hydrotherapy, etc., followed by 

 systematic exercise and suitable diversion. 



Surgical. The possibility of successfully removing a pituitary 

 tumor in spite of its deep seated and well protected anatomical situation 

 must be considered one of the greatest achievements of modern surgery. 

 Among the pioneers, who exploited this new domain in surgery may be 

 mentioned Caton and Paul, Horsley, Schloffer(k), Hochenegg(a), v. 

 Eiselsberg, Cushing(&), and Krause. 



The application of surgery in dystrophia adiposogenitalis is largely 

 confined to tumors of the hypophysis or to the pressure effect on the gland 

 of a tumor in adjacent areas. There are two operative procedures; viz., a 

 radical operation for the removal of the gland and a palliative operation, 

 usually a decompression in cases in which the radical removal is contraindi- 

 cated. If the tumor is a benign hyperplasia, a radical operation may give 

 indefinite relief from pressure symptoms. In the palliative operation 

 temporary relief follows in many instances, but no attempt is made at cure. 



