Papas THE INTERNAL SECRETIONS—1920 
tinue to increase in size and activity after the fortieth 
year. Hypertension is the expression of hypermedul- 
lary adrenal activity, in the adult; and this hyper- 
tension is an almost constant factor in the menopause 
“even when there is no arteriosclerosis or other patho- 
logic cause for it.’’* This same writer states that 
nearly all the cases of hypertonic diabetes are seen dur- 
ing the menopause and are similar to those of adrenal 
origin. 
Adrenal insufficiency is comparatively rare during 
the menopause, hyperadrenia being the usual condi- 
tion; but on the other hand, such insufficiency is very 
common in young women and may become more se- 
vere on approaching the climacteric. There may be, 
at this time, melanoderma—a symptom of hypoadrenia. 
The dying out of sexual activity is accompanied or 
preceded by a lessening of pituitary activity. So one 
may expect hypopituitarism to be associated with 
hyperthyroidism and hyperadrenia as the pathogenic 
basis for most cases of normal climacteric. It will 
be recalled that obesity and the weakening of the gen- 
ital function are the two symptoms indicating sub- 
pituitarism. 
ENDOCRINE ASPECTS OF THE MENOPAUSE 
“The essential symptoms of the menopause are ex- 
pressions of the endocrine disturbances making up the 
crisis. These disturbances are sometimes slight and 
sometimes severe, for the climacteric is influenced by 
the factors which act in all the endocrine states.” * 
Chief among these factors are the previous sexual 
life, temperament and disposition, infection, intoxica- 
tion and emotions. When the pituitary is markedly 
involved there is increase of fat, early cessation of 
the menses, the patient is apathetic and indolent. Al- 
most without exception there is hypopituitarism. 
Hence, pituitary treatment is given for premature 
amenorrhea, with increase in weight. 
