1909.] 



The Functions of the Pituitary Body. 



443 



growth is completed, is accompanied, in addition to many of the above 

 symptoms, by an increase in length both of the limb bones and of the trunk, 

 so that the patient affected attains an altogether unusual stature. This 

 also has been found in most cases that have been examined to be associated 

 with tumours of the pituitary body and a concomitant enlargement of the 

 sella turcica. It is probably the case that the changes in the skeleton in 

 acromegaly and gigantism are due to the same cause, operating, perhaps, 

 at different stages during the progress of growth, and that this cause is to 

 be found in an alteration in the functions of the pituitary body.* Assuming 

 from what is known of the above diseases that the functions of this organ, 

 or of a part of it, have to do with the growth and nutrition of the skeletal 

 tissues, it has still to be decided whether the increased and abnormal growth 

 which is met with in them is due to diminution or excess of the activity of 

 the gland. The former view was taken by Marie, who noticed — as others 

 have done since — that the nature of the tumour which is found after death 

 is often such as to have produced complete destruction of the organ, 

 a cancerous or sarcomatous formation having been frequently described. 

 Those who uphold this view look upon the gland as in some way — probably 

 by means of an internal secretion or hormone — regulating the growth of the 

 skeleton, which in the absence of such regulation proceeds abnormally. 

 But the opposite view (Tamburini, 1894, and Woods-Hutchinson, 1894) has 

 also been advocated, viz., that the symptoms of acromegaly and of gigantism 

 are due to a hypertrophic condition of the pituitary, or, according to the 

 very probable suggestion of Woods-Hutchinson, of its anterior lobe alone, 

 which may be considered to produce too great a quantity of a hormone 

 which stimulates bone-growth. The most important argument in favour of 

 this view is derived from the fact that the pituitary tumours which have 

 been found to be associated with the acromegalic condition have in many 

 instances, especially where the tumour has not been unusually large, been 

 described as a simple glandular hyperplasia of the anterior lobe. And in a 

 few cases of acromegaly which have been noted to be unaccompanied by any 

 distinct enlargement of the pituitary, the glandular cells have been described 

 as unusually full of the granules which are generally regarded as indicative 

 of the secretory activity of the cells. 



On the other hand, the numerous instances in which after death the 

 glandular substance of the organ has been found entirely destroyed and 

 replaced by cells of the types met with in malignant growths seem at first 

 to offer difficulty to the acceptance of this view, and to favour the opinion 



* Cf. Woods-Hutchinson (1898, 1900). According to Woods-Hutchinson, the connec- 

 tion between acromegaly and gigantism was first suggested by Cunningham (1891). 



