342 CLINICAL CONSIDERATIONS 



The adreno-genital syndrome is characterized by a mascu- 

 linization of the female. In children it occurs occasionally in 

 males but in the adult it is limited to the female sex. Several 

 cases have been reported 302 in adult males in whom adrenal 

 tumors were associated with some evidences of feminization 

 of the patient. However, the few cases in which this has been 

 described are not convincing and one is inclined to explain the 

 apparent feminization to other causes than to the existence of 

 a tumor of the androgenic tissue. The masculinizing effects 

 induced by a tumor will vary depending upon the age and state 

 of development of the reproductive system in the patient. 

 We can accordingly divide the adreno-genital syndrome into 

 the juvenile type as it occurs in children before puberty and 

 the adult type which gives rise to the condition of adrenal 

 virilism. Besides these two conditions one also finds an hy- 

 perplasia of the androgenic tissue in cases of hermaphroditism. 

 These three conditions will now be described in greater detail. 



THE JUVENILE FORM OF THE ADRENO-GENITAL SYNDROME 



The literature records 24 cases of this condition, 19 of which 

 occurred in girls while only 5 occurred in boys. The adreno- 

 genital syndrome is thus predominantly an affection of the 

 female in childhood. The onset of the disease is usually dur- 

 ing the first two years of life. The condition is marked by an 

 hyperplasia of the androgenic zone which although benign in 

 its initial stages degenerates into a malignant process. This 

 over-activity of a masculinizing tissue leads to the development 

 of the secondary male characteristics — muscular development, 

 deepening of the voice, hirsutism, et cetera. 



The characteristic points of the abnormal sexual develop- 

 ments in female children is the luxurious growth of hair (pubic 

 and sometimes facial), hypertrophy of the labia majora, pro- 

 jection of the labia minorae, and enlargement of the clitoris 

 which may assume a penis-like structure. There is also en- 

 largement, at times, of the ovaries and uterus, but menstrua- 



