866 JOHN R. WILLIAMS 



uria and polydipsia simulating diabetes insipidus. The nature of the 

 process is not clearly understood, but it has been suggested (Moffett and 

 Greenberger) that the hypophysis is affected directly by toxins of the 

 infecting organisms. Tuberculosis, influenza, and syphilis are the most 

 frequently mentioned infectious causative factors. 



Syphilis. Syphilis, particularly, has for years been associated with 

 the syndrome. Fourier described it in 1871. Futcher called attention 

 to the remarkable association of the two maladies in a report of nine cases 

 of diabetes insipidus which he had observed, five of which were apparent- 

 ly due to a basilar syphilitic meningitis. Spanbock and Steinhaus report 

 a case cited by Frank of a woman with syphilis who developed a poly- 

 dipsia and polyuria. Two months later, the patient had disturbance of 

 vision with hemianopsia. The amount of urine averaged daily from six 

 to seven quarts with a specific gravity of 1.002. After treatment of the 

 syphilis for three weeks, the eye symptoms cleared up and in six weeks 

 the polyuria had ceased. Frank (c) also cites two cases of Oppenheim's 

 due to syphilis. The first case exhibited a marked polyuria and polydipsia. 

 Soon after, visual disturbances appeared which later became a complete 

 hemianopsia, The eye symptoms were helped by treatment but the thirst 

 and excessive urination were unchecked. About six months later the pa- 

 tient died. At autopsy a gumma was found in the region of the chiasm. 

 Further back in the region of the optic tract was a growth of more 

 recent date. The second case also exhibited the syndrome of diabetes 

 insipidus and hemianopsia but had no other evidence of brain trouble. 

 The symptoms were promptly relieved by treatment. A few months 

 later the patient died in coma. The autopsy revealed a syphilitic menin- 

 gitis with a typical gumma in the chiasm extending through the crossing. 



Pregnancy. In pregnancy, the polyuria and thirst may at times be 

 so severe as to suggest diabetes insipidus. Maranon calls attention 

 to the disturbed function of the hypophysis during pregnancy and cites 

 a case, reported by Gentili, of a female, age 40 years, suffering from 

 osteomalacia. At the sixth month of gestation, the symptoms of diabetes 

 insipidus developed and were relieved by the administration of pituitrin. 

 Such evidence must be regarded as more or less doubtful. This is further 

 exemplified in two cases recorded by Nicolaysen. The first was in a 

 woman of 44 years. Symptoms of thirst, polyuria, weakness, and anhi- 

 drosis developed gradually after confinement. Temporary relief was ob- 

 tained by the use of pituitrin. The second case was a woman 34 years of 

 age. The symptoms of thirst and polyuria appeared during the last 

 months of pregnancy. There was no conclusive evidence of pituitary 

 involvement in either of these cases. 



During the menopause, symptoms resembling the syndrome of dia- 

 betes insipidus may appear. Maranon records two such cases in his mono- 

 graph. 



