1923. No. 7. A CASE OF "virilisme SURRÉNAL". I I 



On the other hand, with regard to the malformation of the external 

 organs of generation in feminine pseudo-hermaphroditisni, it was formerly 

 supposed that it arose from a hyperplastic development of originally normal 

 genitalia; but on this point Gallais gives a new and plausible ex- 

 planation, in that he assumes that the large suprarenal glands — or the 

 accessory suprarenals or suprarenal tumours present — produce an in- 

 creased amount of hormones, which stimulate the growth of the genitalia, 

 while at the same time this development is also more or less in the di- 

 rection of the opposite sex. 



If this hormone-action begins during foetal life, it "virilises" the foetus, 

 which is born into the world with malformed genitalia. Gallais therefore 

 gathers these cases under one head — "le pseudo-hermaphrodisme surré- 

 nal". If, on the other hand, the hyperepinephry does not begin until after 

 birth, not only are the genitalia in the females "virilised" in the same 

 manner as in the foetus, but, in addition, the secondary sexual characters 

 are affected, there is an abundant growth ot hair, the voice becomes deep, 

 the muscular power increases, the temper changes, etc. This is the type 

 which Gallais classes under the head ot "virilisme surrénal". He gives a 

 typical example of it in a patient of 25, concerning whom he states that 

 at the age of 10 she looked 15, and when 12 had the appearance of a 

 grown-up woman; and after menstruation had begun her voice changed 

 and became gruff, a thick growth of downy hair appeared upon her upper 

 lip, and her muscular power increased greatly. At the age of 18, notwith- 

 standing her woman's clothes, she looked like a big, strong lad such as 

 one could have fun with; but she nevertheless married, as she was the 

 daughter of a wealthy farmer. The marriage was not a happy one. The 

 virilism increased; the growth of hair and moustache was enormous, and 

 a hypertrophy of the clitoris developed, giving it the appearance of a 

 penis in a boy of 12. It was also subject to erections during coition. 

 The husband complained, and the couple were divorced. She subsequently 

 became seriously ill, and upon examination b\' a physician, a tumour was 

 found in the abdominal cavity, and the patient died; but no post-mortem 

 examination was made. The French writer Tlffier has described a similar 

 case in which the phenomena developed after the menopause, and in which 

 the clitoris measured 4 cm. On account of great haemorrhage. Tuffièr ex- 

 tirpated the large uterus, which contained no myomata, but was only 

 hypertrophic. Concerning his other discoveries he writes as follows: 



said that the elder was a female, but was doubtful about the sex of the younger. 

 Eighteen months later they were brought to him again, and then the elder girl had 

 developed a good deal of pubic hair, and the younger child, who was then lound to 

 be a female, had also signs of hair on the pubes. In both cases the cUtoris was 

 much hypertrophied, but there was no menstruation. Strange to say. in a brother of 

 theirs, aged 6. the generative organs resembled those of a grown man, and in his 

 case too, there was growth of hair on the pubes. 



