TESTICLE AS GLAKD OF INTERNAL SECRETION 505 



tumor. These cases are said to have the peculiarity that the testicles do 

 not produce spermatozoa, whereas it is stated that in other types of pre- 

 cocious puberty spermatozoa are produced. This, however, is not absolute, 

 but is simply a presumed fact that should be borne in mind and data 

 obtained upon it whenever circumstances permit. From a scientific point 

 of view, this fact is of great interest as we know that the adrenal cortex is 

 developed from the same embryological structures as the testicular inter- 

 stitial' cells, and histologically the cells of the adrenal cortex have a very 

 similar appearance to the testicular interstitial cells. This fact also bears 

 out the independence of the internal and external secretion of the testicle. 



Two very interesting cases showing the relation of the adrenal to 

 early puberty are those of Luiser and Chas. Adams. Luiser's case was 

 that of a boy, five years and seven months old, height 138 cm., who re- 

 sembled a boy of sixteen to eighteen years of age. All the teeth were 

 erupted except the last four molars. Mons veneris was covered with hair. 

 Penis was 8 to 9 cm. long (in a state of erection 12 to 14 cm.). Testicles 

 were the size of pigeon's eggs. 



A long series of measurements made in comparative measurements 

 showed that he exceeded most of the normal measurements of a fifteen year 

 old boy. At autopsy an inoperable tumor the size of a man's head was 

 found attached to the suprarenal capsule. The thymus was not found but 

 the thyroid, pineal and hypophysis were normal in size. This patient 

 shows beautifully the effect of the testicular hormone upon the thymus. 

 Here is a child five years and seven months old. He should have had a 

 sizable thymus but he has none whatever, showing that the thymus is caused 

 to atrophy by excessive function of the sexual hormone. 



Chas. Adams' case was that of a boy, normal up to ten years, when 

 puberty set in, after which a great development of muscular strength but 

 little increase in height. At fourteen years and nine months, he had the 

 general appearance of a sturdy little man. For two years his complexion 

 was plethoric and dusky and it was necessary for him to shave daily. 



At operation, a large inoperable tumor was found in the region of the 

 left kidney. Patient died one year and five months after the operation. 



The autopsy disclosed an enormously enlarged liver, a retroperitoneal 

 tumor that weighed 8% Ibs., adherent to the left kidney but no trace of 

 left adrenal. Right adrenal was normal. The tumor was a malignant 

 hypernephroma, taking origin from the adrenal cortex. 



The cases of early puberty due to testicular tumors are interesting. 

 The most striking one in the literature is that of Sacchi. His patient 

 was a boy who when about five years of age noted that the left testicle began 

 to increase in size. At nine years of age the boy had a masculine voice, 

 pubic hair, beard, and a marked development of the penis. The left 

 testicle was enlarged, due to an interstitial neoplasm. The left testicle was 

 removed, and four months- afterward the beard disappeared but the hairs 



