DYSTROPHIA ADIPOSOGENITALIS 879 



a rule both menstruation and ovulation are absent, as well as other signs 

 which characterize the development of puberty; namely, a scantiness 

 or absence of axillary and pubic hair, change of voice, etc. In the re- 

 version of sex type in the male there is often a well marked feminine dis- 

 tribution of hair, especially the pubic hair; the face usually remains 

 beardless. 



If the disease first manifests itself after puberty, retrogressive changes 

 occur, which result in genital hypoplasia ; impotence occurs in men and 

 menstruation ceases in women. There is also loss of libido in both sexee. 



Polyuria 



Diabetes Insipidus. In cases of dystrophia adiposogenitalis elimina- 

 tion of urine is frequently increased. This may vary from a slight or 

 moderate increase over the normal (polyuria) to an enormous quantity 

 reaching as high as 13000-15000 c.c. per diem (diabetes insipidus). The 

 latter was formerly attributed to posterior lobe deficiency (Cushing(&)) 

 but more recent investigations (Houssay and Leschke) failed to corrobo- 

 rate this view. Houssay established experimentally a cerebral basal zone 

 within which pricking generated polyuria. This zone is limited in 

 front by the optic chiasm and behind by the peduncle protuberance. 

 Leschke pointed out the fact that while lesions of the hypophysis, such 

 as trauma, sarcoma, metastatic carcinoma, tuberculosis, syphilis, etc., 

 have been demonstrated in diabetes insipidus, similar lesions in the 

 midbrain, especially those involving the tuber cinereum, may produce 

 diabetes insipidus with the hypophysis intact. Removal of the gland 

 does not produce polyuria, whereas a piqure in the tuber cmereum does 

 produce it. He regards the hypophysis as incidental, and, if associated 

 with diabetes insipidus, that the latter condition is due to pressure on or 

 extension of the lesion into the tuber cinereum. 



Veil produced experimental diabetes insipidus which he divided into 

 two classes, according to NaCl concentration. He states that a piqure in 

 the fourth ventricle produces polyuria with an increase of the NaCl in the 

 urine (hyperchloruria) and a piqure in the midbrain produces polyuria, 

 with a decrease of NaCl in the urine (hypochloruria). 



Diabetes insipidus has occurred in individuals with extensive cranial 

 bone lesions. A case reported by Schiiller(c) was associated with definite 

 alterations in the sella and one by Christian, in which very slight sellar 

 changes were observed. 



A personal observation (Group A, case xv), with a positive Wasser- 

 mann and marked thickening of the cranial bones, especially the occipital, 

 and a shallow closed-in sella, due to enlargement and encroachment of the 



