DIABETES INSIPIDUS 865 



before death, a tumor was found occupying the region of the infundibulum 

 extending forward through the lamina terminalis between the frontal 

 lobes and backward into the third ventricle destroying the neurohypophysis 

 and nearly all of the pars intermedia. Moffett and Greenberger report 

 a case in a child of six years in which the X-ray examination revealed a 

 shadow which was interpreted as a tumor involving the hypothalamus, but 

 not disturbing the sella t.urcica. Gushing (a) described a case of a young 

 man with a recurring lymphosarcoma of the neck .and a metastatic growth 

 in the thickened stalk of the pituitary. The patient had marked polyuria. 

 He also reports another interesting case of a woman age forty years. 

 The patient complained of blindness and headaches. A diagnosis of 

 pituitary tumor and primary optic atrophy was made. There were symp- 

 toms of hypopituitarism. A sellar decompression operation was per- 

 formed which provoked a severe postoperative diabetes insipidus which 

 later moderated. The floor of the sella was thin and bulging. The hy- 

 pophysis was found to be a dense mass containing a great increase of inter- 

 stitial tissue. In view of the foregoing experiences, it is obvious that in 

 the presence of the syndrome of diabetes insipidus, one should always 

 bear in mind the possibility of a new growth in the region of the hypoph- 

 ysis, particularly if there be a preceding history of tumor and operation. 



Severe injury to the head is undoubtedly the accountable factor in 

 the production of the syndrome in some cases. The brain area about the 

 hypophysis may be directly traumatized or pressure symptoms may result 

 directly from the extravasation of blood into this region. As a rule, the 

 symptoms of thirst and polyuria are very acute and severe, more so 

 than when the causal agent is an infection or when the syn- 

 drome supervenes for unknown reasons. A case of Redslob's is 

 cited by Frank in which a girl of fourteen years fell, striking her head 

 on a stone floor and becoming unconscious. On recovery to conscious- 

 ness she complained of defective vision and great thirst. After three 

 months, examination of the eyes revealed bitemporal hemianopsia. The 

 amount of urine voided daily was from 3,400 c.c. to 4,100 c.c. Later the 

 polyuria improved but soon returned in increased amount, Frank re- 

 ported a case of an obese male 39 years of age who entered the hospital 

 because of epilepsy which came after an attempt at suicide. Several years 

 before, the patient had fired two 7 mm. bullets into his right temple. The 

 urine averaged six to seven liters daily. Sexual impotence and genital 

 atrophy resulted, otherwise he was apparently physically sound. There 

 were no eye symptoms. X-ray examination showed a bullet in the median 

 line in the middle and posterior part of the sella turcica. This was en- 

 capsulated and acted as a permanent irritant to the pituitary body, pro- 

 ducing a continuous diabetes insipidus and a certain degree of dystrophia 

 adiposogenitalis. 



The acute infectious diseases are occasionally responsible for a poly- 



