CONDITIONS OF HYPERFUNCTION OF THE SUPRARENAL APPARATUS 361 



ovaries. Finally colossal hypertrophy of the suprarenal cortex and a large 

 accessory suprarenal. A similar case had previously been reported by 

 Crecchio. 



Three cases of pseudohermaphroditismus femininus by Fiebiger: Habitus 

 and hairiness quite masculine, larynx masculine, penis and prostate present, 

 no vasa deferentia, vagina, uterus, and ovaries. The last showed the 

 follicle formation. No menstruation; capable of cohabitation. Masculine 

 sexual sense. Very large suprarenals, apparently hyperplasia of the cortex. 

 Fiebiger regards these cases as an especial teratological type. 



Case of Engelhardt. Fifty-nine years. Married a woman at the age of 

 twenty-seven years. Erections were present, but only weak and very rare. 

 Questionable whether ejaculations were present. Beard and mustache. 

 Facial features masculine. Breasts feminine, hands and feet slender. Penis 

 embedded in a cushion of fat. Hypospadia, corpora cavernosa present. 

 Scrotum only indicated by tissue rich in fat, testicles, buttocks, hips and 

 thighs are feminine. Prostate feebly developed. Autopsy showed an 

 aberrant suprarenal struma at the lower pole of the right kidney. The 

 ovaries were small and dense, with sparse, poorly developed, follicles. 



Here also belongs the case of Hepner and Ogston and furthermore the very 

 interesting case of Meixner (case III). This was the case of a new-born 

 child with pseudohermaphroditismus masculinus, bilateral cryptorchidism, 

 with separated and enlarged suprarenal glandular tissue in the neighborhood 

 of the testicles. 



v. Neugebauer mentions in his large work thirteen cases of pseudo- 

 hermaphroditism with suprarenal tumors. 



Summarizing the cases cited : only one case was that of pseudohermaph- 

 roditismus masculinus. The other cases were pseudohermaphroditismus 

 femininus. All cases showed a bilateral swelling of the suprarenal cortex. 



IV. Finally it should be remembered that also in acromegaly there occur 

 certain cases in which hyperplasia of the suprarenals is observed (Delille, 

 Fischer, and Fischer and Schultze}. Fischer and Schultze find the entire 

 suprarenals, cortex as well as medulla hyperplastic, while Delille observed 

 only a hyperplasia of the cortex. It is very probable that in the future when 

 we pay more exact attention to these relations we will find hyperplasia of 

 the suprarenals, and especially of the cortex, in many cases of acromegaly. I 

 would also call attention to the fact that in many cases of acromegaly, there 

 occurs both in men and women abnormally abundant hairiness. In women 

 the hairiness may assume quite the masculine type. 



Surveying the entire field of facts, one is surprised by the wealth of 

 clinical observations that properly classified demonstrate that from the su- 

 prarenal cortex there proceeds an enormous influence on the growth of the 

 body, and the genital sphere, and on the hairiness, therefore on an important 

 secondary sexual character. Until a short time ago these connections were 



