DYSTROPHIA ADIPOSOGENITALIS 909 



desquamating; the fingers are short, thick and often broad at the ends; 

 the face is round, lips thick, and expression dull. 



Gonads. The most difficult problem encountered in diagnosis is 

 the differentiation between a certain class of cases of hypophyseal dys- 

 trophia adiposogenitalis and the adiposogenital dystrophy of the eunuchoid 

 type. The fact that genital atrophy has been regarded by some authors 

 (Schiiller(6) ; Tandler & Gross) as the primary cause of Frohlich's syn- 

 drome, and that the type of obesity is identical in the two conditions (van 

 Noorden) suggests close similarity. Falta(c) divides dystrophia adiposo- 

 genitalis into two clinical groups the primary hypophyseal and the pri- 

 mary eunuchoid. The eunuchoid grows tall (above the normal average 

 size), the extremities are disproportionately long, so that the distance from 

 the symphysis pubis to the heel is longer than the rest of the body. Hypo- 

 pituitary individuals are usually below normal in height, and the dis- 

 tance from the top of the head to the symphysis is longer than the lower 

 extremities, measured from the symphysis. Brain pressure symptoms and 

 sellar deformation are absent in eunuchoidism, and the epiphyseal junc- 

 tures remain open much longer than they do normally or in hypophyseal 

 dystrophy. Eunuchoidism is always associated with genital hypoplasia, 

 which is frequently absent in hypophyseal dystrophy. 



Adrenals. The asthenia, low blood pressure, and pigmentation as- 

 sociated with hypopituitarism have been ascribed to hypoadrenia the 

 suprarenal glands in these cases have been found to be very small. 



Pineal. A form of obesity resembling dystrophia adiposogenitalis 

 occurs in lesions of the pineal gland. Cerebral, local and general, pres- 

 sure symptoms occur similar to those of pituitary origin. These cause 

 visual disturbance, stupor, mental disturbances, epileptiform seizures, 

 polyuria, and genital dystrophy. The chief differentiating feature is that 

 the genital dystrophy results in hypergenitalism with excessive growth of 

 pubic and axillary hair. 



Adiposis dolorosa (Dercum's disease) and dystropnia adiposogenitalis 

 have many points in common. The cardinal symptoms of the former (viz., 

 adiposity, pain, asthenia, psychic disturbance) may all occur in the latter. 

 The character of the obesity, which appears as large lipomatous masses 

 often irregular in distribution and usually painful, is the chief distinguish- 

 ing feature. The disease is probably of pluriglandular origin. Lesions 

 of the thyroid, ovaries, and adrenals, as well as the pituitary, have been 

 found at autopsy. Other forms of adiposes and lipomatoses occur, but 

 these have no close resemblance to the obesity of dystrophia adiposo- 

 genitalis. Lyon (1910) reported a series of cases belonging to this group 

 and gave a complete bibliography, and recently Sprunt (1920) revised 

 and reviewed the subject up to date. 



