ADRENOGENITAL SYNDROME 349 



skin by the imposition of the skin of a small masculine contour 

 over a large female pelvis. 



The larynx assumes a masculine form with development of 

 an Adam's apple and a deep voice. 95 



In the early stages of the disease, there is marked adiposity 

 which is limited to the upper half of the body. Later cachexia 

 and progressive asthenia occur, at which time there is a palp- 

 able tumor of the adrenal. 



The female reproductive system undergoes a change in which 

 there is suppression and atrophy of the female organs and 

 hypertrophy of the male elements. The clitoris, the female 

 analogue of the penis, becomes enlarged and may assume the 

 form of a penile organ with well-developed glans and prepuce. 

 In such cases the undersurface is grooved, as in hypospadias. 

 The vagina, mons veneris, and labia become atrophied. In a 

 large series of cases in which laparotomy was performed, Bros- 

 ter and Vines 95 noted constant changes in the ovaries which 

 were atrophic and often cystic and degenerated. The fundus 

 uteri and cervix were small. 



Amenorrhoea is an important symptom. In the adreno- 

 genital syndrome appearing after puberty, the menses become 

 irregular, intermenstrual periods lengthen, the flow becomes 

 diminished and finally ceases completely. 



Certain other clinical symptoms have been described as 

 associated with adrenal virilism — hypertension, pain in the 

 lumbar region, migrainous headaches, et cetera. Of greater 

 importance are nausea, vomiting, weakness, and rarely pig- 

 mentation on the forehead and border of the axilla. The last 

 named symptoms are those of Addison's disease and are due 

 to the encroachment of the malignant androgenic zone on the 

 true cortical tissue. 



Psychologically, the development of male characteristics 

 with suppression of the female may be marked by homosexual 

 tendencies. The psychic disturbances so common and pro- 

 found in subjects in whom the reproductive system has under- 



