VIRILISMUS 357 



hirsutismus may bo observed in the young woman, who at puberty grows 

 a small downy mustache and in the older woman who at menopause de- 

 velops a small mustache and also a more or less abundant beard and hairi- 

 ness of the chest, back and extremities. In these cases there is a lack of 

 evidence of a cause for the condition, except the atrophy of the uterus and 

 ovaries in the older women, and explanation of the cause must depend 

 upon the analogy they bear to more pronounced cases with pathological 

 findings. There is also the more marked type in which the hairiness occurs 

 in association with abnormal growths of the ovaries and suprarenals. 



The case of Bovin illustrates the condition which is associated with 

 suprarenal tumor : A multipara of twenty-one years had gradually ceased 

 to menstruate. There then developed a beard, which necessitated shav- 

 ing, and an abundant growth of hair on the abdomen. Her general health 

 was good, breasts were well developed and external genitalia normal. When 

 she was twenty-eight Bovin removed a tumor in which the left ovary was 

 imbedded. The microscopical description shows that it was a hyper- 

 nephroma of an adrenal rest. The right ovary was atrophic and the uterus 

 was like that of a virgin. No note is made of the condition of the supra- 

 renals. Two months after the operation menstruation was reestablished 

 and continued regularly. Seventeen months later the uterus was of normal 

 size. No change, however, occurred in the unusual hairy growth. 



The syndrome has also been associated with tumors both of the ovary 

 and suprarenal. The case reported by Knowsley Thornton is of this class : 

 A married woman with one child had an oophorectomy done when she 

 was thirty. There developed soon after the operation a growth of black 

 silky hair all over the body : she shaved her face regularly. When she was 

 thirty-six Thornton removed a tumor attached to the left kidney. The 

 microscopic examination revealed, a structure which Reminded the ob- 

 server of the structure of an adrenal." After her recovery she reported that 

 her external appearance was like that of other women. We understand 

 from this that the hair disappeared. Cases of hirsutism accompanied by 

 hypernephroma of the suprarenal cortex have also been reported by Thum- 

 min, Winkler and Goldschwend. 



The same condition has been observed in insane women. L. Harris- 

 Liston reports four such. In three of these the hairiness appeared before 

 menopause and in one after it. In all the insanity occurred first. All 

 were in good health except for the insanity and none were mannish. No 

 pathological evidence is offered in these cases. But Linser found in the 

 museum of the Royal College of Surgeons a carcinoma (probably hyper- 

 nephroma) which completely replaced the right suprarenal. It had been 

 taken from a single woman of thirty-two, who had ceased to menstruate 

 and had a profuse growth of hair on face and legs. She was maniacal 

 .and epileptic. 



All of these women noted above had normal genitalia and distinct 



