THE SYMPATHETIC SYSTEM 205 



certain cases, the rapid increase in height and the appear- 

 ance of diabetes insipidus h been the first symptoms. 

 The duration varies from 3 to 18 months with some 

 remissions. Death is the end. It may occur during an 

 epileptiform attack or from an intercurrent pulmonary 

 affection, or the patients become slowly cachectic and 



die in coma. 



DIAGNOSIS. 



The preceding symptomatology is very characteristic, 

 but it may be missing. 



Certain pineal tumors are very slow. Others take on 

 the appearance of a tuberculous meningitis. Others 

 finally are manifested by a hydrocephalus syndrome or 

 compression and give the appearance of an ordinary brain 

 tumor without any dystrophic manifestations. 



We will only discuss the diagnosis of complete syn- 

 dromes in which pineal disturbance is very definite. 



The increase in the height, the precocious appearance 

 of the secondary sexual characteristics, obesity are symp- 

 toms which may belong to other glandular syndromes, the 

 pituitary in particular. 



GIGANTISM differs from the pineal syndrome: 1. Ab- 

 normal growth (lack of proportion); 2. Atrophy of the 

 genital organs. 



FROHLICH'S SYNDROME is characterized by obesity, 

 but there is a genital atrophy. 



ADRENAL VIRILISM resembles the pineal syndrome, due 

 to the obesity and the precocious appearance of the 

 secondary sexual characteristics. It is, however, more 

 frequent in women. The height remains stationary; 

 there is a hyperasthenia and a remarkable hypertrichosis 

 and finally while evidences of cerebral tumor are absent, 

 palpation reveals the existence of t-timor in the region of 

 the kidnev. 



