ENDOCRINE ASPECTS OF OBESITY 65 
Several interesting points are to be noted in this 
case. First, the fallacy of relying upon radiograms of 
the sella turcica to determine the size of the pituitary 
and judging therefrom that the organ is functioning 
improperly. This case was thought before death to be 
an atypical one of adiposo-dystrophia genitalis, with 
fatty degeneration of the heart, and consequent myocar- 
dial insufficiency. Postmortem examination revealed 
a normal pituitary as far as morphology is concerned, 
but showed chronic pancreatitis and marked fatty de- 
generation of both adrenals. The adrenal obesity de- 
scribed by Gallais* is associated with tumors of the 
adrenal cortex and is accompanied by genital hyper- 
trophy. The latter finding is present in this case, but 
the adrenals showed a degenerative condition, which, 
however, may have been a secondary process following 
previous hypertrophy. 
The first case cited was apparently one of hypothy- 
roidism, but the weight-reduction was only slight and 
the return to normal weight was not possible by the 
use of thyroid extract because a greater dosage than 
was used was contraindicated by disproportionate 
marked rise in pulse-rate and blood pressure. There 
were other factors entering into the case suggesting 
involvement of the ovaries and pituitary. Therapy 
along these lines is being followed but the time is too 
short to report results. 
Cases 2 and 3 also illustrate the pluriglandular view- 
point, as it is difficult to state which ductless gland was 
responsible for the obesity. This is particularly true 
in case number 3, which showed signs of marked 
adrenal involvement, namely, early and sudden graying 
of the hair following emotional shock, which Cannon? 
has shown markedly affects these glands. Areas of 
marked depigmentation surrounded by heavily pig- 
mented skin also points to dysfunction of the chromaffin 
