284 THE DISEASES OF THE HYPOPHYSIS 



attracts attention also when it is developed only relatively slightly on ac- 

 count of its characteristic distribution. Moreover, the literature frequently 

 emphasizes that in spite of the slight ingestion of food, even in spite of the 

 development of a certain cachexia, antemortem, the retrogression of fat 

 was only very slight. I shall later report a case (case Sch, Observation 

 XXXVII) in which a marked adiposity developed in a short time. Then 

 attacks of cerebral vomiting occurred several months, on account of which 

 the ingestion of food was prevented sometimes for days. The boy now lost 

 in weight, it is true, but on account of the residual cushion of fat on the 

 mons Veneris and the delicate texture of the skin the type remained still 

 unmistakable. 



There also exist cases of hypophysial dystrophia without obesity. Rennie 

 reports such a case and remarks that he was unable to find a similar case in 

 the literature. Probably in such cases the abnormal distribution of fat 

 would, however, be recognizable. Such a case is reported by Kummel. I 

 also shall later report such a case (Observation Gr, XLV). Moreover, I 

 shall report a case of dystrophia adiposo-genitalia, probably of hypophysial 

 origin (Observation Fr, XLIV) who on his entrance into the clinic was 

 very much emaciated on account of a nutritional disturbance. In him also 

 the fat collection on the mons Veneris was unmistakable in spite of the ema- 

 ciation. When he came under better condition for nourishment in the clinic, 

 the obesity with the typical fat distribution developed rapidly. 



The excessive degree of obesity is regarded as endogenous. This con- 

 ception is based, as we shall see later, on the investigations of the respiratory 

 exchange of gases, which in some cases of hypophysial dystrophy shows pro- 

 nounced lowering of the fundamental exchange, while in other cases the 

 lowering is not at all considerable. 



It is to be expected that in hypophysial dystrophy just as in primary 

 genital adiposity the muscles are permeated with fat, as they are, as is known, 

 in castrated animals. Up to the present this condition has had very little 

 attention paid to it except that Marinesco andGoldstein report a case of typical 

 dystrophy with microscopically recognizable damaging of the hypophysis 

 through a hydrocephalus, in which the fat-permeation of the muscles was 

 apparently found. At all events Marinesco and Goldstein assume a specific 

 nutritional disturbance of the muscles. 



In dystrophia adiposo-genitalis the skin shows a quite characteristic 

 texture. It is often described as alabaster-like, is remarkably delicate and 

 white, mostly is cool to the touch, and sometimes is dry and exfoliates readily. 

 In some, apparently rare, cases myxedematous-like swellings of the skin are 

 distinctly present. Some cases are reported to have falling-out of the hair 

 (see Observation XXXIV). On the contrary, the trophic alterations of 

 the nails seem to be rare. 



The following case shows typical distribution of fat: 



