412 THE DISEASES OF THE SEXUAL GLANDS 



1. By the growth in height. In the hypophysial form, so far as it sets in 

 in childhood, is found pronounced inhibition of growth; in the eunuch- 

 oidal form is found even tallness, or at least no growth disturbances. 



2. Eventually through the behavior in metabolism. In the severe forms 

 of hypophysial dystrophy the fundamental exchange is usually dis- 

 tinctly reduced in the end; in the eunuchoid form the reduction is 

 perhaps not considerable enough to become demonstrable. The 

 answer to these questions will depend on further investigations. 



3. Through the cerebral manifestations in hypophysial dystrophy. 

 Here in most cases are found signs of a hypophysial tumor or of, at 

 least, a tumor in the hypophysial region, or at least signs of increased 

 brain pressure. One should not forget, however, that cases of eunuch- 

 oidism at the time of puberty not at all rarely complain of headaches; 

 and occasional vomiting may occur (two cases under my observation) . 

 In such cases the X-ray examination of the sella is very important. 

 At all events there are also processes that may destroy the hypophysis 

 without distinctly altering the sella and producing symptoms of brain- 

 pressure; for examples gummata or chronic inflammations. Such proc- 

 esses indeed set in after completed development. Hence here comes 

 into consideration the differentiation from late eunuchoidism or from 

 multiple ductless glandular sclerosis. 



The blood examination in the hypophysial as well as the eunuchoid form 

 mostly shows a pronounced mononucleosis. Hence here there is no dis- 

 tinguishing factor. We can at most say that in the hypophysial form, at least 

 in the severe cases, the hemoglobin and the erythrocyte count are often more 

 markedly reduced. 



Prognosis and Treatment. Very important is the observation of Tandler 

 and Grosz, that in the eunuchoidism that sets in early, developmental dis- 

 turbances of the sexual glands are often only temporary (prepubertial eunuch- 

 oidism). Hence such cases may be improved. One of my cases showed 

 such a condition. At the sixteenth year (Observation Sch) the voice had 

 changed, the genitalia had developed almost normally, but as yet there had 

 occurred no pollutions. In these cases the obesity is only improved for the 

 abnormal distribution of fat still exists. In such cases we would recognize 

 the developmental disturbances later in life by the distribution of fat, and 

 probably also by the hair condition. Also it is very probable that in these 

 cases the function of the sexual glands disappears prematurely. Case II 

 of Josef son and Lundquist seems to point in this direction. 



Rapid improvements have been reported from the thyroidin treatment. 

 A pert mentions a case complicated with cryptorchidism in which arfter one- 

 half year's treatment with thyroidin, the penis had distinctly grown, the 

 testicles had lowered, and the weight had increased about 2^ kg. 



Also Parhon and Mihailesko report a similar case in a fourteen-year-old 



