HYPOPHYSIAL DYSTROPHY 



303 



do with the dwarfism. In this case the sexual organs were well developed. 

 This speaks against the existence of the hypophysial affection since youth. 



In May, 1911, 1 observed a case that perhaps belongs to this category. 



Observation XLIII. M. S. P., forty-one years old, from Palestine. Entered the 

 clinic May, 1911. Family history good. The patient states that his genitals have 

 been of the present size since childhood. In spite of the fact that the penis is diminu- 

 tively small, it is subject to erections. First coitus at the age of twenty-two years. 

 Coitus was then practised several times a month up to the 

 twenty-sixth year. The pleasurable sensation was very 

 great, but there h#d never occurred an ejaculation. Also 

 now the penis sometimes becomes erect, the erections last- 

 ing for six to eight hours; they are associated with intense 

 voluptuous sensations. We ourselves saw such an erection, 

 the penis measuring 3 cm. 



For three years the patient has suffered with violent 

 right-sided headaches. There exists a slight right-sided 

 ptosis and paresis of the superior oblique and inferior oblique 

 muscles with diplopia. 



The patient is 154 cm. tall; span width 172 cm., lower 

 length 97 cm.; he is somewhat fat, and there are abundant 

 accumulations of fat on the hips and on the mons Veneris. 

 Hairs of the beard are entirely absent, and there is very sparse 

 hairiness of the mons Veneris and the axillae. The penis is 

 diminutive, and there is a slight hypospadias . The scrotum 

 is very small. There is bilateral cryptorchidism. 



X-ray. Both clivi sharpened, entrance to sella widened. 

 Floor of sella not essentially deepened. 



Examination of the eye-grounds; both papillae present a 

 washed-out appearance, old neuritis. 



Blood count: Erythrocytes, 5,000,000 

 Hemoglobin, 65 per cent., according to Sahli 

 Leucocytes, 10,000, of which: 

 Polymorphonuclear neutrophiles, 50.1 per cent. 

 Large mononuclears, 15.0 per cent. 

 Lymphocytes, 24.4 per cent. 

 Eosinophiles, 0.5 per cent. 



Adrenalin subcutaneously (o.ooi gm.), no glycosuria. 



At first I regarded this case as a eunuchoid, in which a certain function 

 of the genitalia was retained. Also the proportioning of the body seems to 

 me to speak to the same effect. Against pure dysgenitalisTn speaks however : 



1. The disturbance in growth (both patient's parents are large in- 

 dividuals) . 



2. The disturbance of eye muscles, the symptoms of brain pressure, and 

 the X-ray findings. 



As the genital disturbance had action already in earliest youth, the eye- 

 muscle disturbance first becoming apparent only about four years ago, we 

 must think of a gradually developing hypophysial tumor. This may be a 

 teratoma. 



FIG. 57. Teratoma of_the 

 hypophysis. 



