346 INTERNAL SECRETION 



Dystrophia adiposogenitalis is regarded by some authors 

 (Schiiller, Tandler, and Gross) as the result of primary genital 

 atrophy. The influence of the internal secretory activity of the 

 sexual glands upon metabolism, and especially the obesity which 

 has long been known to follow the suppression of these organs, 

 will be "described in a later chapter. If we consider, however, 

 that the hypoplastic constitution shows, in addition to the signs 

 of infantile habit, hypoplasia of the genitals, together with a 

 remarkable development of the fat-body, we cannot be far 

 out in assuming adiposis cerebralis to be the result of defective 

 genital function together with secondary changes in other internal 

 secretory organs. It is, however, worth noticing that, out of 

 thirty-two cases of hypophysal obesity, twelve only showed 

 genital atrophy; and that genital involution was not always 

 observed in the earlier stages of the disease. 



It is hardly possible, in view of the results of experimental 

 extirpation, to doubt the primary significance of the hypophysis in 

 the causation of dystrophia adiposogenitalis. The extirpation of 

 certain portions of the hypophysis, as well as of the entire organ, 

 is followed by symptoms in animals which have a profound 

 resemblance to the clinical type of hypophysal disease which 

 Frohlich described. Experimental investigation by Gushing and 

 by Aschner, as well as the results of my own experiments, all 

 show that partial hypophysectomy is invariably followed by a 

 considerable increase in the fat body, and by hypoplasia of the 

 sexual glands and of the entire genital tract. In the young- 

 animals which Aschmer operated upon there was also persistence 

 of the infantile habit. These experimental results show, more- 

 over, the nature of the derangement which takes place in the 

 hypophysal function. If the symptoms described are induced in 

 animals by experimental apituitarism, it is safe to conclude that 

 the clinical type described by Frohlich results from reduced hypo- 

 physal activity or hypopituitarism. 



This assumption does not appear to be confirmed, however, 

 by the results of the operative treatment of dystrophia adiposo- 

 genitalis. One of the first operations for hypophysal tumour 

 successfully performed by v. Eiselsberg was upon the patient 

 described by Frohlich. The operation was followed by the dis- 

 appearance of the local symptoms due to the presence of the 

 tumour, while at the same time there was an improvement in all 

 the general symptoms which were attributable to the hypophysis. 

 The weight fell, the obesity was reduced, hair grew at the pubes 

 and in the axillae, and sexual activity manifested itself by erec- 

 tions. The disappearance of the dystrophic symptoms after the 

 removal of the hypophysal tumour appeared to be a weighty 

 argument against the theory of hypopituitarism. There is, how- 

 ever, another side to the question. If we assume that the tumour 

 only was removed, and that the hypophysal tissue was otherwise 



