E. Perry McCULLAGH

The role of the seminiferous tubules in the production of hormones.

Tables 2, 3, and 4 are reprinted from the Journal of Clinical Endocrinology. 11: 1403. Nov. 1951.

Diabetes of Anterior Pituitary and Adrenal Cortical Origin

In recent years it has become increasingly clear that diabetes mellitus, once considered a disease entity, must in the future be looked upon as a group of diseases which have one common feature—hyperglycemia. Disorders which cause hyperglycemia vary greatly and in essential ways. Although it is possible in some instances to point to reversal of diabetes to a state of cure even after it has persisted for a long time, it must also be recognized that long-sustained hyperglycemia, regardless of its cause, may in itself be sufficient in some individuals to precipitate lasting pancreatic diabetes. The various forms of diabetes which are emerging most clearly (to be added to pure beta cell failure) include pituitary diabetes due to excess of growth hormone, diabetes due to excess of corticotropin (ACTH), and diabetes due to excess of adrenocortical steroids of the 11-oxysteroid type.

Diabetogenic Action of the Pituitary: Clinical Observations

All thoughtful students of diabetes are well aware of the fact that carbohydrate metabolism is controlled by the interplay of a variety of factors. The average clinician gradually is coming to realize the importance of studies of these factors, for with a better understanding of human diabetes there will come better control and eventually, it may be hoped, prevention or permanent cure of the disease. The known and theoretical causes of human diabetes continue to multiply. In addition to failure of insulin production, we think of the possibility of disturbances such as excess of glucagon or excess of immune-like bodies or other blocking agents affecting insulin efficiency. It appears likely that hyperglycemia if sufficiently great or of sufficient duration may precipitate lasting diabetes in some patients. In them, no matter what mechanisms are involved etiologically, it also seems likely that eventually true insulin deficiency may supervene. However, there is evidence that such diabetes may be both severe and temporary as illustrated by the remarkable case reported by del Greco and Scapellato. In their patient the intake of huge quantities of sugar and honey was followed by hyperglycemia, severe glycosuria, and wellauthenticated typical diabetic coma. The patient later completely recovered not only from the coma but from the diabetes as well, the glucose tolerance becoming normal. The reversal of diabetes or its disappearance is an unusual occurrence, but each piece of evidence produces renewed hope for eventual means of a cure. The study of diabetic conditions that are associated with the pituitary or the adrenals therefore is of special value not only in revealing complexities of carbohydrate metabolism but also in showing us methods by which we gain a little more insight into means of reversing diabetes.

Stable and brittle diabetes.

Abstract 1.1. A classification of diabetes, based on the study of 172 patients, is presented. An attempt is made to separate persons with stable diabetes from those with brittle diabetes, and to express diabetic control in these patients. 2.2. The incidence of degenerative complications was higher in patients with stable diabetes than in those with brittle diabetes. 3.3. The incidence of severe diabetic retinopathy (grades III and IV) in adult patients with brittle diabetes with long-standing diabetes was very low. 4.4. Patients with stable diabetes with poor control showed a significantly higher incidence of late degenerative complications than patients with stable diabetes with good control. 5.5. Further indications are presented to support the concept, already described in the literature, that there are two types of diabetes mellitus which should be looked upon as distinct metabolic entities.

Transsphenoidal Yttrium 90 Hypophysectomy in the Treatment of Breast Cancer

Transsphenoidal yttrium 90 hypophysectomy has proved to be a simple and effective method of pituitary destruction. Objective remission was obtained in 30 per cent of 69 patients with breast cancer. Stainless steel screws loaded with yttrium 90 are implanted through the sella turcica.