HYPOPHYSIAL DYSTROPHY 283 



In the year 1901, A. Frohlich on the exhibition of a case that came from 

 v. Frankl-Hochwart's dispensary first coined the diagnostic dictum that 

 rapidly developing obesity, infantilism of the genitalia, and myxedematous 

 alterations of the skin suggest tumor of the hypophysis. 



The case reported by Frohlich was that of a fourteen-year-old boy in whom 

 the disease began two years before the presentation, with headaches, vomit- 

 ing, and rapid increase in weight. He had a characteristic distribution 

 of fat, such as will be described later, the genitalia remained entirely infantile, 

 there was no hairiness of the genitalia, the axillary region and the trunk, 

 and the skin showed slight signs of myxedema. Since that time numerous 

 cases such as this have been reported by v. Frankl-Hochwart's assistants, 

 A . Berger, by Erdheim, Zak, A . Fuchs, Bartels, Madelung, Launois and Cleret, 

 Babonneix and Peisseau, Creutzfeld, Neurath, Bychowski, Marinesco and 

 Goldstein, Jutaka Kon and others, and finally several cases by v. Frankl- 

 Hochwart. A series of cases'is presented by the author in course of the follow- 

 ing exposition. 



Definition. By hypophysial dystrophy we understand a clinical picture 

 characterized by accumulations of fat in definite places or eventually by pro- 

 nounced obesity of definite localization, such as is found in eunuchs and eu- 

 nuchoids; further by inhibition of development or by subsequent atrophy of the 

 interstitial glands and the glands of generation, and corresponding inhibition 

 of development; or by more or less distinct retrogression of the secondary sexual 

 characters and of the genitalia; further, when the disease occurs in youthful 

 years, by inhibition of growth and inhibition of ossification. Finally, on account 

 of a sluggishness of the entire metabolism, there is often added as a symptom 

 of irritation a polyuria; there are also added symptoms of pressure on the part 

 of the optic nerves. A lessening or a loss of the function of the glandular 

 hypophysis called forth by processes in the hypophysis itself or in the vicinity 

 of the hypophysis may be looked upon as a cause of this condition. 



Symptomatology. One of the most important symptoms is the obesity, 

 with a quite definite type of fat-distribution, such as is found also in primary 

 inhibition of development of the genitalia. The agreement in the distribu- 

 tion of fat in the two types (the primary genital and the hypophysial dystro- 

 phia adiposo-genitalis) was first mentioned by v. Noorden. The accumula- 

 tion of fat is chiefly localized to the hips, the buttocks, the mons Veneris, 

 and the mammae. 



In the higher degrees of the fattening the abdominal wall is affected 

 especially in its lower part, where there may develop thick fatty layers. 

 These were seen in several cases; when they were removed the patients felt 

 considerably relieved. The supraclavicular and infraclavicular fossae may 

 become quite covered over by pads of fat. There is found, moreover, a collar- 

 like collection of fat on the neck, and as Launois and Cleret call them, fatty 

 cuffs on the malleoli. The obesity may attain an excessive grade, but it 



