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 8 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 9 

 has shown markedly affects these glands. Areas of 

 marked depigmentation surrounded by heavily pig- 

 mented skin also points to dysfunction of the chromaffin 



