CLASSIFICATION OF DISORDERS OF THE HYPOPHYSIS*

Abstract

To have the opportunity of submitting a classification of the disorders of the hypophysis to this audience, many of whom have done original work upon this gland, is indeed a privilege. This presentation is made with the view that the many complexities encountered in correlating the clinical manifestations of these disorders, with the changes in function and histology of the hypophysis, will be clarified by its discussion. The primary essentials relative to the physiology of the pituitary body, upon which this classification is based, have been deduced almost entirely from the theoretical conclusions of pituitary function advanced by American investigators (Cushing, Goetsch, Homans, Crowe, and Bab). The application of these principles has been stimulated by our analysis of 892 endocrine cases, of which 147 were diagnosed disorders of the pituitary gland; 350, of the thyroid ; 194, of the gonads; 186, pluriglandular disorders; 10, diseases of the adrenals and 5, thymus diseases. Of the 123 hypopituitary disorders, 23 were grouped as anterior lobe; 3, as pos terior lobe; and 86, as bilobar insufficiencies. The hyperpituitarisms totaled 24, of which 6 were anterior lobe; 2, posterior lobe, and 16, bilobar varieties. There were 11 cases of diabetes insipidus, or hypophyseal polyuria, some of which were associated with an anterior lobe or a pars nervosa syndrome. Pituitarism as a part of a pluriglandular complex (not included in the 147 primary pituitary disorders) occurred in 122, making a total of 269 cases in which clinical manifestations of pituitarism were present. Of the total number of pituitary cases, only 8, or 6 per cent, were neoplastic in origin. Conclusions, dependent upon the differentiation of the clinical manifestions determined from comparing pituitary with other endocrine disorders, have substantiated to a considerable degree the theories of the functions of the individual lobes of the pituitary gland.