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. Fam- 

 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. 



