PITUITARY CACHEXIA

1502 incision was made, and the femoral canal was exposed. It was found empty. Overlying the fossa ovalis the subcutaneous tissue was oedematous and in its substance several enlarged pink inflamed lymph glands were exposed. One of these was removed for biopsy, and on section showed the typical microscopic picture of an intensive lymphocytic infiltration with numerous areas of haemorrhage within the substance of the gland. The post-operative course was relatively uneventful. The wound healed by primary union and the swelling tenderness and pain disappeared two days after operation. The temperature remained elevated at 102° for one day after the exploration and then subsided by lysis. An alveolar abscess developed in the right maxillary region and a small furuncle on the right ear, both of which readily disappeared. The patient left the hospital twenty days after operation, feeling quite fit.

There are several features of this case, the reasons for which must remain conjectural. What was the site of primary focus for the lymphadenitis ? Radiography of the right hip showed no abnormality, while a plate of the right knee showed firm bony union between femur and tibia and a small sequestrum feeding the sinus. The character of the sinus and its discharge had apparently remained unaltered for .years, and certainly showed no acute manifestations during the patient’s stay in the hospital. Whether there was any causal relationship between the adenitis and the patient’s occupation at the moment when his symptoms appeared so dramatically must also remain in doubt. And lastly, the very

prominent gastro-intestinal symptoms which made this case so closely mimic an acute abdominal emergency cannot be explained with certainty. indebted to Mr. D. Denham Pinnock for permission to report this case. I

am

toms of myxoedema were present though there were no serious intellectual disturbances. The urine was clear and showed neither albumin nor sugar (specific gravity 1008-1013). The blood pressure was 110/80, and the daily variations in her temperature were from 95’0 to 975° F. Radiography showed a pituitary fossa of normal size. Blood count : hsemoglobin 70 per cent., red cor-

puscles 3,700,000, leucocytes 5500 (polymorphs 42 per cent., eosinophils 3 per cent., monocytes 1 per cent., basophils 1 per cent., lymphocytes 53 per cent.). The B.M.R. (basal metabolic rate) was minus 40 per cent. on admission. Carbohydrate metabolism was upset, and the accompanying chart shows that blood-sugar values obtained under fasting conditions were abnormally low. The peculiar peaks which are common to all the curves are very striking. Patients like this are extremely sensitive to insulin, and in this patient the blood-sugar remained man

shows the readings obtained after the patient had 30 grammes dextrose at 7.50 A.M. Curve 2 shows the of adrenaline (gr. 1/120 hypodermically) fasting. 3 shows the effect of insulin (10 units hypodermically) fasting. After the insulin injection the patient remained hypoglycsemic for 24 hours and the administration of 30 grammes dextrose at 9.5 A.M. had-as will be seen-no influence on the curve.

Curve 1 taken effect Curve

PITUITARY CACHEXIA

(SIMMONDS’S DISEASE) TREATED WITH ANTERIOR LOBE EXTRACT

BY LEO RAU, M.D. FORMERLY

ASSISTANT

PHYSICIAN, RUDOLF VIRCHOW HOSPITAL, BERLIN

VARIOUS forms of endocrine therapy have been tried in cases of pituitary cachexia-e.g., thyroid and ovarian extracts-but none have been useful. In the following case an extract of anterior lobe of the pituitary proved efficacious given by mouth. The preparation used was dried anterior lobe containing all its fractions and not merely the identified sex and growth hormones. The patient, aged 56, had had complete amenorrhaea for twenty years, dating from the birth of her third child. The labour had been normal and the temperature was But after the confineher head and body within a few months. There was also considerable loss of weight, but this had been regained during the past ten years, the gain being associated with cedema of her face. Within the last two years the patient had become very weak, with much fatigue, and was unable to walk. She felt very cold during summer and winter. Neither her memory There was no history nor her intelligence were impaired. of previous illnesses; her husband had met with an accidental death. On admission the patient was found to have very pronounced oedema of the face and of the eyelids, general haemorrhagic purpura, a very dry skin, and scleroderma on both legs. Downy hair was entirely absent; hair was missing from armpits and pubes, and was very thin on the top of the head. It was also lacking on eyebrows and eyelids. She was extremely weak, and typical symp-

normal

during

the

puerperium.

ment she lost all the hair

on

for fully 24 hours after an insulin injection of 10 units despite a plentiful supply of carbohydrates. The cause of this sensitiveness to insulin is not known.

depressed

first treated for three weeks with 0’1 g. thrice daily but without success. At the end of this time the B.M.R. was minus 38 per cent. She was then given dried anterior lobe substance by mouth, and after two months’ treatment the hair on head and the downy hair had begun to grow again. The oedema had entirely disappeared, and the patient was able to walk again and stand unaided. The B.M.R. had risen to minus 20 per cent. and subsequently reached minus 14 per cent. The fasting blood-sugar values had gone up to 80-85-90 mg. per 100 c.cm., and the daily range of her temperature had risen to 968-982° F. The improvement in the B.M.R., and the rise in temperature and in fasting blood-sugar values can be explained only by the influence of the anterior lobe treatment. The dosage was 150 mouse units a day for eight months with an interval of one week in every month. After this course of treatment, administration of extract was stopped for ten months, but it had to be resumed. After the extract was stopped she felt very well and fairly strong ; but 10 months later she again became weak and was able to walk short distances only. Her hair became thinner and she lost weight again, but there was no cedema. The

patient

was

Thyroidein tabl. (Merck)

SWANDBAN ISOLATION HOSPITAL.-Proposals for extensions to this hospital at a cost of over f,24,OOO have been approved by Worthing town council.