871 



In liis monograph, Maranon describes in detail seven types of sellse which 

 are observed in alterations of the hypophysis. He states that it is very 

 difficult to give figures as to the size .of the normal sella such as could 

 be measured in the shadow of the radiograph. One therefore has to judge 

 of its normality or abnormality by its size in relation to the dimensions 

 of the individual, by the state of ossification, and form. The following 

 are abnormal types of sellse: (a) The large form with a wide and deep 

 cavity enlarged in all directions with form of* normal shadow, and ob- 

 served in cases in which congenitally there exists a large hypophysial 

 development. Clinically, there are symptoms of gigantoacromeguly more 



Fig. 4. Case Mrs. W. Third observation three and one-half years later. Visual 

 and color fields approximately same as at first examination, except that in lower 

 temporal field of left eye there is a marked quadrantal visual and color defect. 



or less accentuated. In children with hypophysial tumors of rapid growth, 

 this type can be seen, the walls of the sella, being still pliable, widen 

 in all directions, (b) The small sella, which is shallow in depth and nar- 

 row in width, but preserving in general the shadow of the normal struc- 

 ture. This type is observed almost always in cases of congenital hypo- 

 plasia of the gland (primary hypopituitarism, Gushing). Clinically, this 

 type is seen in cases of infantilism and cachexia. (c) The narrow and 

 deep sella. These cases are almost always due to congenital hypoplasia 

 of the hypophysis, also noted at times in cases of tumors which increase 

 in depth, especially early in life when ossification is not complete, (d) 

 The wide and shallow type. This generally means a developed tumor in 

 the somewhat more advanced stages and which grows upwards destroying 

 the anterior and posterior clinoidal processes, (e) In some cases the 

 entire shadow of the sella and of the sphenoidal processes has disappeared, 



