166 ENDOCRINE GLANDS 



These symptoms of virilism with hirsutism (Apert) are 

 the first to appear. Sometime afterwards appear symp- 

 toms of adrenal insufficiency : emaciation, extreme asthe- 

 nia, hypotension, lumbar or thoracic girdle pains, and 

 examination reveals the presence of an abdominal or 

 pelvic tumor. 



2. In children, if we are dealing with a little girl 

 between 5 and 6, they are characterized by an extraor- 

 dinary amount of strength for their age. The genital 

 organs (penis, testicle) are as large as those of a child of 

 14. Hairs appear, not only around the genital organs, 

 but on the face, limbs and back. 



Adrenal virilism is nearly always caused by a malignant 

 tumor, which is fatal to the patient in a few months. Two 

 years is the maximum. 



III. ABORTIVE CASES. 



In adult women or at the menopause, it is possible to 

 observe the symptoms of an abortive form of genito 

 adrenal syndrome, compatible with long life (due in 

 these cases to benign tumors) and characterized by the 

 disappearance of the menses, a somewhat noticeable 

 adiposity, with or without pigmentation and a hyper- 

 trichosis of masculine systematization. 



PATHOLOGICAL ANATOMY. 



On autopsy of these patients are found in all cases 

 tumors of the adrenal cortex and atrophic lesions of the 

 ovaries. The adrenals show unilateral or bilateral vari- 

 able lesions. 



In the cases of pseudo hermaphroidism, one or both of 

 the glands are lobulated and increased in size (whether 

 dealing with plain hypertrophy or adenoma). In the 

 cases of adrenal virilism are observed more often malignant 



