DYSTKOPHIA ADIPOSOGENITALIS 905 



rectly syphilis is undoubtedly responsible for many cases. In 

 fact, Peritz(fc) is of the opinion that syphilitic hydrocephalus 

 is the most frequent cause of hypophyseal lesion. 



Trauma is an occasional factor as demonstrated by Madlung's case 

 so often quoted. The case is that of a girl 9 years of age in which a bullet 

 lodged in the sella turcica, producing all the symptoms of dystrophia adi- 

 posogenitalis. 



In six of Cushing's hypopiituitary cases early symptoms were ap- 

 parently incited by trauma. Five of these cases were associated with 

 tumors. 



Alterations at the Physiological Epochs. Owing to the normal physi- 

 ological alterations, associated with puberty in both sexes, and menstru- 

 ation, pregnancy, lactation and the climacteric in the female functions 

 regulated and controlled through the endocrin system individuals are 

 particularly prone during these epochs to develop certain endocrinopathies, 

 especially those referable to the pituitary, thyroid and gonads. This is 

 due to the direct influence of tho interstitial cells of the testes and ovaries 

 upon the pituitary and thyroid functions. 



According to these sex epochs Schumann classifies dystrophia adi- 

 posogenitalis in women into three groups. 



1. Hypopituitarism before puberty, corresponding to Frohlich's type. 



2. Hypopituitarism appearing after sexual activity has developed, 

 frequently beginning during the period of betrothal and reaching 

 its height in the month immediately following marriage. The 

 condition continues unchanged from two to five years when either 

 spontaneous improvement takes place or develops into the adipose- 

 infantile-sterile type of "fat women." 



3. Hypopituitarism in normally matured women with normal men- 

 struation, who have borne one or more children. After the birth 

 of the last child there occur lactation atrophy, superinvolution of 

 the uterus, amenorrhea, obesity, excessive carbohydrate tolerance 

 with cirrhotic changes in the ovaries and atrophy of the uterus. 



In one of the writer's most typical cases of hypopituitarism with well 

 marked fat dystrophy girdle type symptoms began to develop almost 

 immediately after a course of radium treatment for uterine fibroid (Group 

 A, Case VIII.) 



Infections play an important etiological role. Histological changes 

 in the hypophysis have been observed in individuals who died from in- 

 fection (Delille). Experimental infection on animals produced similar 

 changes. These consist of hyperplasia of either the anterior or posterior 

 lobe, depending upon the nature of the organism. The effect which acute 

 infectious diseases (e, g., typhoid and rheumatic fever) have upon the thy- 



