OBESITY 



45 



TABLE II. BASAL METABOLISM IN HYPOPHYSEAL OBESITY 



reduction of more than ten -per cent, and in two, of more than 15 per cent. 

 Since undernutrition can be excluded as a cause, it seems fair to conclude 

 that hypophyseal obesity may be accompanied by a lowering of the basal 

 rate. 



The mode in which hypopituitarism reduces the metabolism is an in- 

 teresting matter for speculation. The close interrelation of the pituitary 

 and the thyroid renders the interpretation difficult. Thus Gushing 

 found changes in the thyroid in all of his fifteen cases of pituitary in- 

 sufficiency in which the gland could be examined, with excess of colloid 

 and a low epithelium lining the acini. It is therefore possible that the 

 lowered metabolism is due to secondary changes in the thyroid. Another 

 possibility is that the normal pituitary secretion stimulates the thyroid 

 gland to increased activity, and still another that it has a direct effect 

 on the metabolism. The increased sugar tolerance found by Gushing in 

 hypopituitarism, and the subnormal temperature are in favor of this view, 

 especially as the contrary state, with elevation of the temperature and 

 hyperglycemia, can be produced by injection of extract of the posterior 

 lobe. Moreover, Gushing was able in some cases of hypopituitarism to 

 produce a marked diminution of the obesity by feeding pituitary sub- 

 stance. 



The effect of the administration of pituitary extract on the basal metab- 

 olism has not been sufficiently studied. In one of Means' cases, in which 

 the diagnosis of hypopituitarism was considered probable, no effect was 

 noted. 



In addition to the increased sugar tolerance, which in some cases is 

 so marked that 400 grams of levulose may be given without its appear- 

 ing in the urine, a marked diminution of the blood sugar may occur, the 

 very low value of O.Q4 per cent being reported by Gushing. 



Rosenbloom(^) in a study of a case of dystrophia adiposogenitalis, 

 found the metabolism normal as regards sulphur, calcium, magnesium and 

 phosphorus. 



