ADRENOGENITAL SYNDROME 347 



Except for the arrhenoblastoma of the ovary, which occur 

 very rarely in children, 475 the juvenile form of the adrenogeni- 

 tal syndrome should offer no difficulty in diagnosis. Ar- 

 rhenoblastoma of the ovary give rise to a condition which is 

 identical, as far as one can judge from the few cases in the 

 literature, to the adreno-genital syndrome. This identity in 

 the manifestations of the two disorders supports the view that 

 the ovarian cells which give rise to the arrhenoblastoma and 

 the androgenic tissue are functionally equivalent. The diag- 

 nostic errors so frequently encountered in determining the cause 

 of precocious development in children is due to the failure to 

 appreciate the fact that adrenal tumors do not give rise to true 

 sexual precocity and that the occurrence of regular menstrua- 

 tion or spermatogenesis precludes, therefore, the possibility 

 of an adrenal tumor as the cause of the disorder. Failure to 

 appreciate this fact, first pointed out by Krabbe, 365 has led to 

 futile operations on the adrenal when the ovary, testicle, or 

 pineal were the true sites of the disorder. In only two cases 

 cited in the literature has menstruation been observed in chil- 

 dren suffering from adrenal tumors. In one case" the patient 

 was eleven years of age and in the other 655 (the patient of 

 Figure 17) the bodily development was that of an adult. In 

 both cases the menstruation occurred at rare intervals and was 

 small in amount, thus differing from the cases of true precocious 

 development in which a normal and regular menstrual flow 

 may begin in infancy. 



ADRENAL VIRILISM 



By this term, we shall refer to the adreno-genital syndrome 

 as it occurs in adult women. It occurs most often either 

 during the early years of adolescence or at the time of meno- 

 pause, that is, at those periods in life when the reproductive 

 cycle is undergoing most rapid change. Cases have been re- 

 ported, however, not infrequently in patients of intermediate 

 ages. 95 ' 203 



