1923. Xo. 7- A CASE OF "virilisme surrénal". I5 



question at once arises as to whether this is a fatty degeneration of the 

 cells or an infiltration of fat, or whether, finally, the fat is the expression 

 of a secretion-phenomenon. As it is a malignant tumour with which we 

 are concerned, it would not be strange if we also found parts of it affected 

 by fatty degeneration, as so frequently is the case in this kind of tumour: 

 but in the first place the contents of fat are uniform throughout the tumour, 

 and in the second place I have not found any indication of degeneration 

 in the cell-nuclei. I can therefore disregard the possibilitv of a fatty 

 degeneration, and the question of an infiltration of fat is quite overshadowed 

 by that of whether the fat-globules are the expression of glandular activitv. 

 The appearance of the periphery of the left suprarenal favours this view. 



It is well known that the cortical cells of the suprarenal gland contain 

 globules of fat — lipoids. With regard to the genesis of these lipoids, 

 the Danish investigator. Dr. Borgberg, writes, in his great work on the 

 lipoids of the suprarenal gland, that it might well be thought that this 

 was a "physiological fatty degeneration" in the suprarenal gland similar to 

 that found, for instance, in the sebaceous glands ; but, as against this view, 

 he points out that as regards the suprarenal gland it must be assumed 

 that it is not in the old, dying cells that fatty degeneration takes place, 

 as is the case with the sebaceous glands, but that, on the contrary, it is 

 in the most actively functioning cells that there is most "fatty degeneration". 

 In other words, the fat found in the cortex of the suprarenal gland is the 

 physiological secretive product of the cell. 



It is not improbable, therefore, that these lipoids represent the virilising 

 hormones. Whether the fat-globules in the tumour-cells are identical with 

 the corresponding lipoid in the nonnal suprarenal cells is another question. 

 In his work on piihertas prœcox, Krabbe writes that when, in this 

 condition, a tumour is found in the suprarenal, it may well be imagined 

 that it is the tumour which secretes substances which, by means of the 

 Le\digian cells, influence the secondary sexual characters. Krabbe does 

 not believe, however, that the normal suprarenal cortex has any such 

 function. 



It is easy to explain the origin of virilism by Kr.abbe's theory when 

 it occurs in boNS, but difficult to e.xplain the hormones' virilising influence 

 s^en in girls with suprarenal tumours, or the virilising action occurring in 

 old women, of which Tuffier's case is a good instance. Does the virilising 

 here, too, take place through the interstitial cells of the ovary, which in 

 that case must be regarded as homologous with the Leydigian cells in the 

 testicle? This is the difficult question. We do not know whence the Ley- 

 digian cells come, and our ignorance of the origin of the interstitial cells 

 in the ovary is still greater, as we do not even know whether the so-called 

 lutein-cells are a special group of interstitial cells in the ovary. If the 

 virilising takes place by means of the interstitial cells, the explanation, as 

 we have said, is verv easv as resrards bovs; but in the case of female 



