THE SYMPATHETIC SYSTEM 187 



often cyanotic. These patients are dyspneic, due to the 

 fat which infiltrates into the retro peritoneal cellular tissue, 

 the greater omentum mesentery and even the viscera. 



The obesity follows a progressive course and can 

 become tremendous. Children of lo can weigh as much 

 as 50 or 60 kilograms. Adult women sometimes exceed 

 100 kilograms. 



2. DYSTROPHIA GENITALIS. Genital disturbances, 

 always associated with obesity, vary with the age. In 

 children puberty does not occur. The testicles stay infan- 

 tile, the secondary sexual characteristics are missing; 

 the hairs do not appear; the voice stays high pitched. 

 In women, the menses become irregular and finally dis- 

 appear. In man, frigidity and impotence are the rule. 



ETIOLOGY. 



The adiposo genitalis syndrome has many causes. l 

 In certain cases pituitary tumors have been noticed; in 

 others, tumors at a distance from the pituitary ; in others, a 

 serious meningitis or hydrocephalus compressing the gland. 

 The syndrome may appear following a traumatism; in 

 the classical observation of Madelung a girl of six received 

 a rifle bullet wound in the head. During the following 

 years appeared a marked obesity. At 9 years of age she 

 weighed 42 kilograms. Exceptionally luetic or tubercu- 

 lous lesions of the pituitary are to blame. 



PATHOGENESIS. 



Since the observation of Frohlich, it is believed that the 

 syndrome of adiposo-genitalis is the result of disturbances 

 of function of the pituitary. 



1 Clinically these individuals present evidence of thyroid and ovarian deficiency. 

 Lack of ovarian stimulation is noticed in the relative or absolute amenorrhoea and 

 sterility, primary or secondary. Thyroid deficiency is noted by symptoms approaching 

 more or less closely the picture of myxedema. 



