"Dyspituitarism", twenty years later : with special consideration of the pituitary adenomas / Harvey Cushing.

  • Harvey Williams Cushing
Date:
[1933?]
Catalogue details

Licence: Public Domain Mark

Credit: "Dyspituitarism", twenty years later : with special consideration of the pituitary adenomas / Harvey Cushing. Source: Wellcome Collection.

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    tion of normal menstruation in women previously amenorrheic, for which there can be no other ready explanation than the release of the sex-activating cells from their pressure inhibition.* I*ragments of a chromophobe adenoma, so far as I know, have been tested only twice by implantation methods to determine the presence or absence of an active hormone, with contradictory results.¢ There, how- ever, is a further reason for believing that their clinical syndrome is not attributable to a secretory product. ‘This is based on the complete absence of any recognizable symptoms except those of chiasmal involve- ment “° when one of these tumors, owing to a defective diaphragma sellae, has escaped from its intrasellar confinement and come to lie in such a position that the activity of the rest of the gland continues unimpaired (cf. fig. 2 //). While this argument may appear to have been unduly belabored, it seems necessary at the outset clearly to distinguish between the two actively secreting types of adenoma, subsequently to be considered, and these chromophobe tumors whose somatic effects, so far as one can determine, are purely hypopituitary. Though the chromophobe adenomas are by far the most common type—the proportion in our series of 385 verified cases being 277 chromophobe, 107 acido- philic and “mixed,” and 1 basophilic—the opportunity to study an early example post mortem has never arisen, and their more common point of origin is unknown. They vary considerably in their histologic appearance, some of them having an architecture suggesting an origin from the pars intermedia, others being structure- less masses of cells in whose cytoplasm nonstainable granules suggesting secretory activity may sometimes be detected. Whereas in the normal pituitary gland mitotic figures are not seen and are rarely if ever picked up in fixed and stained preparations of the adenomas, they occasionally may be detected on supravital preparations (cf. fig. 6). Nevertheless, these pitiutary adenomas, while they may crowd their way into the cranial chamber and cause death, never seem to acquire malignant tendencies. A few examples, possibly 2 per cent of the 385 cases, have been called adeno- carcinoma by pathologists who have examined the tissues. But the fact that the patients from whom the specimens were taken, in spite of an incomplete removal of the lesion, have all survived the operation for many years belics the diagnosis of malignancy, and at the same time speaks in favor of their being composed of elements possessing no functional activity. * That the adiposogenital symptoms brought about by these adenomas are not ascribable to involvement of the interbrain by the enlarging tumor is evident from the fact that an associated tuberal polyuria is exceedingly uncommon and is rarely elicited by the surgical manipulations necessary to expose and remove one of them. On the other hand, polyuria is a common feature of hypophysial duct tumors (craniopharyngiomas), the study of which led Erdheim to advance his hypo- thalamic explanation of the symptoms in Fréhlich’s disease. And even should polyuria not have occurred spontaneously from the effects of a growth of this kind which is more apt to be suprasellar than intrasellar in position, it is almost certain to be produced by the operative manipulations necessary for its removal. + Kraus alludes briefly 7 to his having observed on a single test a positive follicular effect. Berblinger,22 on the contrary, observed no effect on a single test.
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