An insulin hypoglycemia test and a 30-min ACTH test were performed in 90 patients with proved or suspected hypothalamic-pituitary-adrenal hypofunction and in 10 normal subjects. The peak plasma cortisol concentration during hypoglycemia and the cortisol concentration at 30 min after injection of 250 micrograms corticotropin 1-24 were compared. A very close correlation (r = 0.92) was found between the the two concentrations, with no major discrepancy in any case. It is concluded that the short ACTH test accurately reflects the integrated hypothalamic-pituitary-adrenal function, as assessed by the insulin hypoglycemia test.

No abstract

All cases of pituitary abscesses (19 patients) reported in the literature since 1970 are reviewed. Based on the data available, it is suggested that a pituitary abscess is not a bacterial infection as commonly assumed. Probably, it represents a normal tissue reaction to an infarction of a pituitary adenoma. The frequent association with negative cultures from the abscesses, previous sterile meningitis and endocrine disturbances, and concurrent rhinorrhoea are well explained in this way.

IT IS NOT an uncommon occurrence in carotid angiography that after the first injection of contrast medium nonfilling or incomplete filling of the cerebral vascular tree is found. Thus, if the opaque medium is visible at all, only the internal carotid artery may be filled, while its terminal branches, that is, the middle and anterior cerebral arteries, cannot be visualized. This is true even though no major obstructions can be disclosed and the time of exposure remains unchanged. Repeated injections into the same artery, and injections into the opposite one, will usually result in an angiographic demonstration of the entire vascular tree. At times, however, partial filling will ensue even on repeated injections, resulting in a series of films apparently indicating a holding up of the contrast medium due to obliteration of the internal artery.Within the current year, however, five cases have come under our observation that may shed light upon the physiopathological processes involved in what will be shown to be quasiobliterations of the cerebral arteries. These were five cases of an intracranial space-taking lesion in which signs were revealed in the angiogram of a holding of the medium in the internal carotid artery, although in no case was an anatomical obstruction of the artery found at a later stage. The nature of the lesions varied widely. Common to them all, however, was the fact that the space-taking lesion had led to a sudden rise in the supratentorial intracranial pressure, and that at the time of angiography signs were present of severe herniation of the brain stem through the incisura tentorii, with ensuing severe disorders of consciousness and of circulation, together with respiratory embarrassment, even increasing to cessation of respiration.The case records will be summarized with particular regard to points relevant to the subsequent discussion. REPORT OF CASESCase 1.-Large cyst in the left cerebellar hemisphere in a man aged 33. On Aug. 8, 1951, the patient was transferred to the department of neurosurgery from the department of neurology of this institution. For about a year he had complained of attacks of severe fronto-occipital headache, precipitated by stooping and, later, by even the slightest moveFrom the State

Although bromocriptine, a dopamine receptor agonist, is now widely used in the treatment of acromegaly, there have been no controlled trials of its biochemical or clinical effects on this disorder. We assessed its effects in a double-blind, crossover study. Eighteen patients with acromegaly were given bromocriptine and placebo alternately for three months per medication. Their responses to oral glucose-tolerance tests during the two regimens did not differ significantly. The number of patients noting amelioration of clinical symptoms during treatment with bromocriptine was almost identical to the number with clinical improvement during placebo. We conclude that it remains doubtful whether bromocriptine has a beneficial effect in acromegaly.