348 CLINICAL CONSIDERATIONS 



The adreno-genital syndrome as it occurs in women is 

 marked by an appearance of secondary male characters and a 

 retrogression of the female sex characters. Among the former 

 are 1) hypertrichiasis of the male type, 2) changes in bodily 

 contour, 3) changes in the larynx, 4) hypertrophy of the clitoris, 

 and 5) the assumption of the psychological outlook of the male. 

 The retrogression of female characteristics is marked by a 

 cessation of menstruation and the loss of other female char- 

 acteristics which are replaced by the masculine characters 

 already noted. The above mentioned changes may now be 

 discussed in further detail in the order in which they have been 

 enumerated above. 



The development of hair of the masculine pattern is one of 

 the most prominent signs of adrenal virilism and has given rise 

 to the term adrenal hirsutism as descriptive of this syndrome. 

 The degree of this hirsutism is variable. It is often distributed 

 over the entire body. On the face it is commonly a moustache 

 or beard. It may cover the thighs and chest and appear in 

 patches over the dorsum of the feet and proximal phalanges. 

 The axilla and pubis are well covered, the latter assuming the 

 triangular distribution characteristic of the male. In older 

 women baldness of the masculine type has also been described. 95 



The bodily contour assumes a masculine form particularly 

 when the syndrome develops early. The patients are broad- 

 shouldered, narrow-hipped, and muscular. The breasts are 

 usually undeveloped or may retrogress. In certain cases (cf. 

 Figure 17) they appear large but these are probably composed 

 of fatty tissue and part of the tendency to increase in weight 

 which is observed in the early stages of virilism. Broster and 

 Vines 95 found the involutionary changes of later life in one of 

 their cases. 



A peculiar striation of the thighs was described by Gallais 210 

 and has been noted by subsequent authors as occurring in this 

 condition. This may possibly be explained as analagous to 

 that occurring during pregnancy and due to stretching of the 



