THE PITUITARY 383 



however, not invariably accompanied by diabetes insipidus. 

 The experimental and pathological evidence is not conclusive. 



Treatment of patients by means of subcutaneous injection of 

 pituitary extracts seems to have given some very striking 

 results. According to Kennaway there is very frequently an 

 immediate restoration of a normal state of the urine when pitui- 

 tary extract is given in diabetes insipidus. This writer also 

 urges that the fact provides strong evidence for the normal 

 activity of the gland in regulating the secretion of urine. 



In pituitary disease conditions of primary over-activity 

 become blended later on with symptoms characteristic of 

 known stages of functional insufficiency. So that in certain 

 conditions it may be difficult to tell which predominate (Gush- 

 ing). It will be remembered that Tamburini in 1894 described 

 a " two-stage " process in acromegaly ; a glandular hyper- 

 trophy with hyperactivity characterizing the first stage, while 

 in the second or terminal there occur degenerative changes 

 with diminished activity and resultant cachexia. 



O. The Use of Pituitary Extracts in Medicine, Surgery, 

 and Gynaecology 



Reference has already been made to the use of pituitary 

 extracts in acromegaly. We have seen that they have not 

 been found to be beneficial in this disease. Nor should we 

 expect them to be of service if acromegaly be, in fact, due to a 

 hyper secretion of the gland. 



But there are many other conditions in which pituitary 

 preparations have been recommended and employed. 



In conditions of shock, pituitary preparations are believed 

 to be of more value than adrenin. This is due partly to the 

 fact that pituitary preparations (" pituitrin," " infundibulin," 

 etc.) keep the blood-pressure raised for some considerable time, 

 while the effect of adrenin is very fleeting. Saline infusions 

 should, however, be used ; reliance should not be placed on 

 the pituitary extract alone. 



Owing to its powerful action on the uterus (see p. 351), 

 pituitary substance is now employed in many obstetric con- 

 ditions. The action on the uterus was first noticed by Dale, 

 and has since been studied by several observers. Foges and 

 Hofstatter have obtained results similar to those of Dale and. 



