Progress in clinical endocrinology depends largely upon the successful application of knowledge derived through extensive experimental animal research. It is generally assumed that there is a parallelism between the results obtained in man and those obtained in animals. There are instances, however, in which this corollary does not apply, and the reactions in man occur in an antagonistic or paradoxical manner as compared to those occurring in animals. The case which we herewith report, of pituitary dwarflsm with diabetes mellitus, is an example. There have been only a few such cases recorded in the literature. Sexton and Neuhoff (1) recently reported a somewhat similar case. We are presenting our case in the hope that it may stimulate further research and investigation, and ultimately solve this unexplained clinical phenomenon.Clinically, Goetsch, Cushing and Jacobson (2) early pointed out the presence of decreased sugar tolerance in cases of hyperpituitarism. Cushing (3) demonstrated that hypophysectomy creates adipose dwarfs with increased carbohydrate tolerance. Experimentally, Houssay (4) opened the field for further speculation with his hypophysectomized-pancreatectomized dogs. He found that hypophysectomy in dogs causes an increased sensitivity to insulin (5); that hypophysectomy ameliorates diabetes produced by ablation of the pancreas (6); and that in hypophysectomized dogs, injection of anterior lobe substance causes hyperglycemia ( 7 ) . Evans ( 8 ) produced glycosuria and hyperglycemia in normal dogs by injections of anterior pituitary extract.The nature of these observation led to the concept of a diabetogenic principle of the anterior pituitary in order to explain the reactions enumerated above. The diabetogenic substance, as well as the growth factor, is believed to reside in the eosinophilic cells of the anterior lobe. Despite these observations, the experimental evidence does not seem to be conclusive, since it fails to explain satisfactorily the co-existence of pituitary dwarfism (anterior lobe deficiency) and diabetes mellitus (decreased sugar tolerance), the two outstanding clinical manifestations in our case.
CASE REPORTThe patient, referred by Dr. Wilson of Piedmont, West Virginia, is a boy 1 7ŷ ears of age, who has been under our observation for stunted growth and diabetes during the past 2y 2 years. There was no history of dwarfism or diabetes in the family. His parents were both 62 inches tall. Four brothers ranged in height from 67 to 71 inches, and 2 sisters each measured 63 inches. The patient was considered of average size at birth, developed normally and grew fat until the age of 4 years, when he suffered from an attack of rheumatic fever. At the age of 5 he contracted 115 The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 28 March 2016. at 07:25 For personal use only. No other uses without permission. . All rights reserved.
