902 WALTEK TIMME 



i 

 erosion of the anterior or posterior clinoid processes or the floor or dorsum 



of the sella; and in the final stage, an enlarged sella with practically no 

 clinoid processes left at all. In the cases in which 110 compensation is 

 effected i. e., in which fatiguability and the other symptoms remain and 

 progress the sella shows no enlargement (notably that of T. R., Fig. 10). 

 Jt is necessary to be cautious in the interpretation of sellar changes and 

 n safe method would consider only the grosser changes. In these cases 

 there are headaches, periodical in type, adiposity, mental and moral 

 deficiencies, petit mal, and other manifestations. Curiously enough in 

 all cases, the feeding of pituitary gland in fairly large quantity disposes 



Fig. 10. Uncompensated case. Age thirty-five years; height 6 feet. 1 inch. Sella 

 tnrcica completely shut in and extremely small. Confirmed by stereoscopic plates. 

 Intratemporal headaches; adiposity; moral lapses; pathological liar. Much improved 

 by treatment. 



of many and at times of all these symptoms. But if the feeding is 

 diminished or stopped, the symptoms reappear. It seems analogous to 

 thyroid feeding in myxedema. One case, which gives a typical early 

 history and seems uncompensated to-day at the age of forty-four, still 

 shows the very small sella turcica with a clinical picture of abnormal bony 

 structure much resembling Paget's disease. On pituitary feeding, this 

 case is improving markedly in its features of fatiguability, headaches, and 

 heaviness of extremities. Finally, the fourth stage is ushered in by a 

 gradual cessation of the fatigue, amelioration of the headaches, restoration 

 of a normal blood pressure, and normal sugar content of the blood. But 

 the adventitious signs of the disturbance of the pituitary gland remain. 

 Thus the fully compensated cases may show acromegaly more or less 

 marked ; and this acromegaly is not to be taken as a diseased condition 

 needing treatment., but simply as the hallmark of a process that has come 



