CONDITIONS OF HYPERFUNCTION OF THE SUPRARENAL APPARATUS 359 



cortex, ovaries and hypophysis were normal. In the case of French (seven- 

 year-old girl) the abnormal hairiness began to develop as early as the 

 eighteenth month; the genital organs were very large; here also was found 

 a suprarenal tumor. 



It will be seen that the condition nearly always affects girls. Of 

 seventeen cases offered by Glynn, fourteen were of the female sex. What 

 is common to all in the clinical picture of these cases is, as Neurath empha- 

 sizes, the premature excessive development of the secondary sexual characters 

 and of the external genitalia. Neurath mentions that in this category of pre- 

 mature sexual development, the function of the generative portion is on the 

 contrary not prematurely developed. This does not always point to an espe- 

 cially intimate relation between the suprarenal cortex and the interstitial 

 glands. Moreover, common to almost all cases is adiposity, furthermore the 

 accelerated growth, probably with retention of the infantile dimensions, 

 and the accelerated ossification and dentition. The development of the 

 psyche in such children as a rule does not keep pace with the bodily develop- 

 ment. Also the development of the sexual instinct is usually slow. 



II. The manifestations that occur on the development of hypernephro- 

 mata in the juvenile or mature organism are likewise characterized by an enor- 

 mous influencing of the sexual sphere. . Here also I would enter more fully in 

 the case reports. The case of Bortz and Thumim was that of a sixteen-and- 

 three-fourth-year-old girl. At first she had developed quite normally, then 

 the menses ceased, and there developed a luxuriant deep black beard and 

 a sparse mustache. Hairs developed on the chest and on the linea alba, the 

 voice became deeper and universal obesity developed. Death occurred as 

 the result of an intercurrent illness. Section revealed atrophy of the ovaries, 

 enormous enlargement of the thyroid gland, normal hypophysis; on both 

 sides there existed a suprarenal tumor rich in blood-vessels that had ap- 

 parently developed only from the cortex. 



Case of Winkler. Sixteen-year-old girl. Abundant black hair on the 

 upper lip. Uterus small. Tumor of the right suprarenal with metastases. 



Case of Bovin. Twenty-eight-year-old woman. Two labors, then cessa- 

 tion of menses at the age of twenty-one. Development of the beard. There 

 is also an abundant growth of hair on the abdomen. Simultaneously, the de- 

 velopment of an abdominal tumor. Operation showed a large ovarian tumor 

 proceeding from separated suprarenal germs. The patient recovered from 

 the operation, the uterus became larger again, menstruation reappeared, and 

 the abnormal hairiness disappeared. However, the observation after opera- 

 tion was for a short period of time only. 



The case of Hegar perhaps belongs to this group (abnormal hairiness, 

 uterus duplex, cystic tumor of the ovary). Moreover, perhaps also the case 

 of Alberti. In this case menstruation was normal up to the nineteenth year. 

 Development otherwise normal. Then set in hypertrichosis, development of a 



