860 HAKVEY G. BECK 



3. Absence of function apituitarism (cachexia hypophysopriva) 



4. Perverted function dyspituitarism (mixed symptoms) 

 Besides akeration of function leads to compensatory disturbance in other 

 endocrin glands (thyroid, gonads, adrenals) with symptoms referable to 

 these organs ; a condition which naturally tends to a more or less complex 

 symptomatology. 



However, dystrophia adiposogenitalis, with which this chapter has to 

 deal, is a well defined syndrome, paralleling in many respects that of 

 myxedema and cretinism occurring in thyroid deficiency, and when un- 

 complicated can be easily recognized. 



Historical 



The earliest observation showing the effect of an arrested endocrin 

 function upon the body is that of the eunuch, which dates to antiquity. 

 The changes in skeletal formation, the abnormal distribution of fat, and 

 the faulty development of the secondary sex characters, due to loss of func- 

 tion of the sex glands, has been well known. Owing to the lack of knowP 

 edge concerning the physiology and pathology of the glands of internal 

 secretion no relation between the loss of function and fat dystrophy in 

 other than the sex glands had been suspected. However, in 1883 both 

 Reverdin and Kocher conclusively demonstrated such a relation with the 

 thyroid by complete extirpation of the gland, and in 1901 Fr6hlich(a.) de- 

 scribed his epoch-making syndrome of hypophyseal deficiency in which 

 obesity and genital hypoplasia were the most striking symptoms. 



Fro'hlich's case was that of a boy fourteen years of age, who had suf- 

 fered two years with headache and vomiting, and had gained weight 

 rapidly. The fat was distributed in a characteristic manner, the genitalia 

 Avere undeveloped, and the pubic and axillary hair was absent. To this 

 clinical picture iBart els (/;) later gave the name of dystrophia adiposogeni- 

 talis. Other cases of obesity with features embraced in the above syn- 

 drome, however without reference to the hypophysis, had been described 

 previously as cerebral adiposity (Schuster). 



Dr. Garrison of the Surgeon General's library, after reviewing the 

 history of the subject stated that possibly the earliest case of true hypo- 

 pliyseal obesity described prior to Frohlich's was reported by Barnard 

 Mohr in 1840 (Wochenschr. f. d. ges. Heilkunde, Berlin, 1840, VI, 565- 

 571). It is interesting to note that in the same volume Basedow's re- 

 markable description of goiter appeared. Mohr's patient was a woman 

 forty-seven years of ai>e with sarcoma of the hypophysis. The chief 

 symptoms were visual disturbances, vertigo, periodical headaches, clumsy 

 movements, mental deterioration terminating with symptoms of apoplexy. 

 An unusual obesity developed with extraordinarily large abdominal di- 



