Association of Multiple Pregnancies with Diabetes of Suggested Pituitary Origin

The patient, a woman, aged 40, had five normal pregnancies before, and six abnormal pregnancies after, the onset of diabetic symptoms. The case differed from typical diabetes in the following respects. In spite of severe thirst and polyuria, lasting untreated for six years, the patient became very fat, and the condition did not progress in the usual way. At the termination of the last pregnancy the glycosuria disappeared and the blood-sugar became almost normal, although the diet was very little restricted and all insulin was omitted. Insulin had only a small hypoglycaemic effect and the blood-sugar curves after glucose were atypical. The fasting level was raised, but the blood-sugar returned to the initial figure in two hours, suggesting that sugar was being well tolerated in spite of the hyperglycaemia. A very severe ketosis and a lowered threshold for glucose were present during the last three months of the pregnancy and disappeared immediately after labour. At labour, extreme hydramnios was obvious, and a very large foetus weighing 12 lb. 6 oz. was stillborn. On the fourth day after the labour 10 units of pituitary extract (1 c.c. pituitrin) produced an epileptiform attack and nearly killed the patient. There was a temporary return of the glycosuria, without hyperglycaemia, and a transient ketosis. The belief that the pituitary is or was involved is supported by the patient's history that her head had grown larger, and by the definite constriction of the temporal fields of vision in both eyes.It therefore seems reasonable to conclude that the disturbance of carbohydrate metabolism was not due to disease of the pancreas causing a deficient production of endogenous insulin, but to the antagonistic influence of a hyperactive pituitary gland associated with repeated pregnancies.