A Brief Consideration of the Present Status of So-Called Pituitary Basophilism

The malady which Dr. Cushing described seven years ago under the name of "pituitary basophilism" has certain characteristic clinical features which, as time proves, are commonly though not invariably found to beassociatedwith abasophilicadenomaoftheadenohypophysis. The outward appearance of the patients is so striking when the syndrome is fully developed that one resembles another as dosely as do acromegalic patients. The victims acquire a round, plethoric face (Vollmondsgesicht), and an obesity which tends to spare the extremities; they become round-shouldered or kyphotic, and cutaneous striae of deep purplish-red color principally distributed over the lower abdomen slowly develop. The disorder proves to be twice as common in women as in men. Amenorrhaea and varying degrees of hirsutism affect the females, and the males become impotent. Clinical tests reveal vascular hypertension, decreased sugar tolerance or actual glycosuria, and the x-rays show a skeletal decalcification which is often so extreme as to lead to spontaneous fractures. While the disorder is apt to progress rapidly and may lead to a fatal issue in the course of a few years, notable remissions in its activity may take place, and in some recorded instances the malady appears to have become quiescent for long periods with retrogression of symptoms. Death in the majority of fatal cases has been ascribed to an infection, often following such trivial causes as a pin-prick, tooth extraction, or retrograde pyelogram. Otherwise, when allowed to run its course, the disease usually terminates with cardiac failure, cerebral hemorrhage, or uremia. The associated pituitary adenomas. A tabulation (cf. Chart) has been made of 67 cases in which post-mortem examination has disclosed a recognizable pituitary lesion, a definite adenoma having been present in 58 instances, viz., in 86 per cent of the cases.t