904 HAEVEY G. BECK 



have made the same reference to the pituitary which he made to the thy- 

 roid, when he stated that the occurrence of simple goiter, often unnoticed, 

 among the relatives of patients is suggestive of congenital alteration of 

 the thyroid; a condition which can be converted into exophthalmic 

 goiter by the influence of infection typhoid fever, syphilis. 



In my series of hypopituitary cases the hereditary character was ob- 

 served in several instances. Thus, in one family the mother presented 

 a typical picture of hypophyseal dystrophy. Three daughters and one 

 son showed evidence of the disease in addition to thyroid deficiency. Two 

 of these had mental symptoms for which they were treated in a psycho- 

 pathic institution. 



Another instance was that of a mother and daughter. The mother 

 was a typdcal case of dystrophia adiposogenitalis. The daughter mani- 

 fested symptoms before puberty obesity and delay of menstruation until 

 sixteen years of age later, after marriage, menstruation ceased and the 

 abdomen became large and protuberant a phenomenon which she at- 

 tributed to pregnancy. An examination at the end of the eighth month 

 revealed the fact that she was not pregnant and the uterus and ovaries 

 were of infantile size. Further investigation showed that she was also 

 a case of true dystrophia adiposogenitalis. 



Age. In many cases there is a congenital predisposition. The dis- 

 ease frequently begins at puberty or during the third decade. One-third 

 of the published cases occurred between thirty and fifty years of age, and 

 one-tenth between fifty and sixty (v. Frankl-Hochwart). 



Sex. The disease appears relatively much more frequent in the 

 female than in the male. This is no doubt due to the fact that the female 

 is peculiarly subjected to disorder of the endocrin system through the 

 special function pertaining to menstruation, reproduction, and the meno- 

 pause. In tumors of the pituitary gland the distribution between the 

 two sexes is about even. 



Congenital Hypopituitarism. Although there are no authentic reports 

 of cases of congenital hypopituitarism, Priesel considers that such do occur 

 in the form of hypophyseal dwarfs, which he divides into two forms; 1. 

 PRIMORDIAL in which the individual is subnormal at birth and develops 

 symmetrically, and 2. INFANTILE in which the individual is normal at 

 birth, but growth becomes retarded between the fifth and fifteenth year. 



Among predisposing factors of a congenital nature may be mentioned : 



1. Developmental abnormalities either osseous, influencing the 

 size and shape of the sella turcica, or glandular through embry- 

 onic defect in which the pituitary is imperfectly developed. 



2. Syphilis Simonds, who reported a case of congenital syphilis 

 of the hypophysis, found ten cases in the literature. Indi- 



