ENDOCRINE ASPECTS OF OBESITY 59 
occurs in individuals when the caloric value of the food 
intake exceeds the energy requirements, the excess 
being stored in the form of fat. The latter is seen in 
cases of lowered metabolism such as occurs in hypo- 
thyroidism and certain other endocrine disturbances. 
This distinction is brought out more clearly by a thera- 
peutic test, it being possible to reduce the weight by 
dieting if the obesity is of exogenous origin, while no 
marked loss of weight occurs under food restriction in 
the endogenous type. This is illustrated very well by 
the following case: 
Miss D. C., aged 20, 5 feet 3 inches tall, weight 142 
pounds. Complaint: Constipation, headache, chilly 
feeling and constantly-decreasing menstrual flow. F'am- 
ily history negative except that her mother was very 
short and obese. 
For the past two years the patient has been getting 
progressively more “dull and lazy.” She is satisfied to 
stay at home and takes no interest in the things that 
used to interest her. She does not care to read because 
of inability to concentrate. She is not nervous, but very 
irritable and impatient which, she says, “‘is quite unlike 
her normal self.”’ She sleeps well at night but awakens 
unrefreshed in the morning, at which time of day she 
feels more irritable and blue. There is a sensation of 
soreness in the throat which is most marked about one 
week before menstruation. At this time there is also 
a sensation of pressure and tightness in the upper chest 
and neck which causes smothering if she lies on either 
side. This seems to be getting worse the past four 
months. 
Her periods have been becoming shorter so that she 
flows only two days where it used to be four or more, 
and the amount now is very scant. She has not per- 
spired at all in the past year though occasionally she 
takes very warm baths. 
