106 



DYSTKOPHIA ADIPOSOGENITALIS 



eyeballs, mons and mammary glands suggest gonadal deficiency, while the 

 classical girdle obesity points to hypophyseal deficiency. 



All gradations of fat dystrophy ranging from the slightest deviation 

 of normal body configuration to veritable monstrosities may be encoun- 

 tered, the degree depending upon the relative diminution of pituitary 

 function and the secondary disturbances of function in other endocrin 

 glands. In complete loss of function (apituitarism) obesity does not de- 

 velop, on the contrary there is loss of 

 weight with emaciation and cachexia 

 (cachexia hypophysopriva) . 



A unilateral dystrophy of fat oc- 

 curred in several of the writer's cases 

 in connection with hypophyseal dys- 

 trophy. This may be suggested by 

 a slight relative increase of size, on 

 the affected side, of the lobule of the 

 ear, and the breast, and perhaps a 

 slight facial asymmetry. It can be 

 more definitely determined by com- 

 paring the measurements of the cir- 

 cumference of the arms and legs. 

 This observation confirms that of 

 Neiden's case, cited by Macnab, in 

 which obesity first manifested itself 

 on the left side, and later the increase 

 in fat became more general. Unilat- 

 eral dystrophy in pituitary disease is 

 not limited to fat. Ilbert Hancock 

 reported a case of a girl ten years old, 

 who had an hypophyseal tumor 

 with obesity and right temporal 

 hemianopsia. There was skeletal overgrowth of the left side involving the 

 face, chest, arm and hand, leg and foot. And Biedl(c) reported a case of 

 unilateral (left side) acromegaly. The condition began as a gradual 

 enlargement of the left arm during the fourth year ; other symptoms were 

 sudden loss of vision, pain in legs, fever, and aniiriu, which were regarded 

 as being due to acute meningeal or cerebral disturbances. Anatomical al- 

 terations of the sella were not demonstrable by X-ray. No satisfactory 

 explanation has been offered for these unique conditions. They obviously 

 cannot be due solely to hormone factors. 



Fig. 24. Unilateral dystrophy of fat 

 in a case of hypopituitarism. 



