SYNDROMES INVOLVING THE PINEAL GLAND 55 



nal genitalia. In a boy six years old, shown at autopsy to have a pineal 

 teratoma, it was noted that the penis was fully equal in size to that of a boy 

 of sixteen or seventeen and pubic hair was plentiful, but the testicles did 

 not seem enlarged. Oestreich and Slawyk, also in 1899, say of their 

 patient, who was four years old, that his penis developed enormously, 

 was 9 cm. in length when flaccid, and his testicles were as large as pigeons' 

 eggs. There was also abundance of pubic hair 1 cm. long. Frankl-Hoch- 

 wart in 1909 says of his verified case in a boy of five that he showed great 

 development of the penis, strong erections, marked growth of pubic hair 

 and deep voice. Raymond and Claude noted that in their case, a boy of 

 ten had pubic hair equal to that of a boy of fourteen or fifteen. In the 

 writer's reported case, of a boy of twelve years, it was noted that the 

 external genitalia were overdeveloped for the age of the patient, that pubic 

 and axillary hair were present, and that the boy's voice changed from pre- 

 pubertal to adult tone between the years of eleven and twelve. 



Other secondary sexual features mentioned are mammary hypertrophy 

 with colostrum present in a boy of 4 (Oestreich and Slawyk), early sex- 

 ual instinct, masturbation and priapism. 



Adiposity, Polyuria, Polydipsia, Drowsiness. These are further man- 

 ifestations of constitutional disorder to which attention has been called by 

 various writers. Marburg, especially, has emphasized the importance of 

 adiposity and went so far as to associate it with an overbecretion of the 

 pineal. In view of the fact that these are all symptoms which are now 

 pretty definitely shown to be dependent upon pituitary disturbance, their 

 specific connection with the pineal can hardly be maintained. This seems 

 the more true because secondary pituitary manifestations, together with 

 marked changes in the sella turcica, occur with great frequency in cases of 

 internal hydrocephalus from any other cause. Pineal tumors almost in- 

 evitably impinge upon the Sylvian aqueduct, so that dilatation of the 

 third and lateral ventricles has been present in almost all of the recorded 

 cases. 



Diagnosis 



The correct localization of pineal tumors ha,s been accomplished 

 antemortem only rarely. In adults no pathognomonic syndrome can 

 be named, but in most instances the cerebellar symptomatology causes 

 the greatest confusion. The most that can be said is that in the presence 

 of an intracranial pressure syndrome which simulates a cerebellar lesion, 

 if there be added to the picture an involvement, of one or both trochlear 

 nerves, together with recurring changes in the size of one or both pupils, 

 and a tendency to spasticity in the lower extremities, a tumor of the pineal 

 body should at least be suspected. 



In children before the age of puberty, however, the case is different, 



