164 ENDOCRINE GLANDS 



Some of these individuals have lumbar or thoracic girdle 

 pains and examination reveals a lumbar tumor sometimes 

 quite voluminous, which in children is mistaken for a 

 sarcoma of the kidney or in adults for a tumor of the kidney. 



In other cases, palpation reveals a tumor in the pelvis. 

 In reality, we are dealing with an ovarian tumor of 

 adrenal origin. 



The diagnosis of adrenal pseudo hermaphrodism comes 

 up: either in a young child having a perineal vulvar mal- 

 formation with hypospadia and cryptorchidism and in 

 which the sex is doubtful; or in adults at the time of 

 puberty. We must remember that the great majority of 

 cases are women in spite of their masculine appearance; 

 that the presence of fatty masses in the scrotum is not 

 indicative of the presence of testicles (we might also have 

 supranumerary adrenal glands), that certain hematurias 

 which are mentioned by the patients are really menses 

 and that all pseudo hermaphrodites should have a careful 

 examination of the abdomen and the pelvis. 



II. ADRENAL VIRILISM. 



This type differs from the preceding by the time of its 

 appearance. It comes on at a time when the sexual 

 differentiation is already completed, and in which the sex 

 is not in doubt. It is characterized by modifications of 

 the secondary sexual characteristics and develops parallel 

 to the adrenal tumor. 



Virilism may appear either in young girls after puberty, 

 or in women after the manopause (late virilism), or 

 in children. 



1. In the young girl or in the woman, the menses stop 

 and the morphology changes: the hairs of the body 

 develop excessively; a mustache develops together with a 

 beard, hairs on the abdomen, on- the thorax and the limbs, 



