DYSTEOPHIA ADIPOSOGEKITALIS 90 7 



In a cursory review of the literature the following varieties of hy- 

 pophyseal lesions have been encountered, namely, adenoma, glioma, psam- 

 mona, metastatic carcinoma, adenocarcinoma, teratoma, sarcoma amn- 

 oma, cystoma, steatoma, chondroma and fibroma; other lesions include 

 gumma, tubercles, embolism, trauma, hydrocephalus, etc. In Frankl- 

 Hochwart's collection of cases without acromegaly there were 



27 sarcomata 



15 cysts 



43 adenomata 



12 carcinomata 

 9 strumata 

 7 tubercles 

 3 gummata 

 3 gliomata 

 2 teratomata 

 1 steatoma 

 1 chondroma 

 1 fibroma 

 1 unidentified 



Diagnosis 



The diagnosis of dystrophia adiposogenitalis typus Fro'hlich is 

 ordinarily not difficult. The triad upon which the syndrome is based con- 

 sists of obesity, skeletal undergrowth and hypogenitalism. To complete 

 the clinical picture alterations in the sella turcica and neighborhood signs 

 and symptoms, including distortion of the visual fields, should be added. 



However, such a classical illustration is not presented in the average 

 case. Variations occur either owing to the absence of some of the above 

 mentioned symptoms or to additional features not embraced in the typical 

 syndrome. These include (a) atypical forms, (b) early cases, (c) milder 

 types, and (d) pluriglandular varieties in which the hypophyseal symp- 

 toms predominate. 



(a) Examples of the atypical form are some of the hypophyseal dwarfs 

 (Lorain type) in which there is marked skeletal undergrowth and infantile 

 genitalia but without obesity. In other instances there may be enormous 

 obesity and genital hypoplasia with skeletal overgrowth. Illustrative of 

 this form is Griffith's case of a boy eleven years old with all the char- 

 acteristics of Frohlich's syndrome except the skeletal. He was 5 feet and 

 1 inch tall (8 inches above normal for his age) and weighed 251 pounds 

 with an abnormally small sella and high sugar tolerance. Hypopituitary 

 dystrophy secondary to hyperpituitarism (gigantism, acromegaly) pre- 

 sents an atypical appearance owing to the enlargement of the acra (nose, 



