38 



pituitarism, was made by Cushing(c), to whose work we owe so much of 

 our knowledge of this subject. 



The original Frohlich's syndrome, also called dystrophia adiposo- 

 genitalis, included undergrowth of the skeleton. Further experience has 

 shown that another type exists, characterized by skeletal overgrowth. 



As emphasized by Gushing, hypopituitarism may result from a pri- 

 mary hypoplasia of the gland, from hemorrhage, inflammatory proc- 

 esses (especially syphilis) or from tumor. A tumor of the interpedun- 

 cular region by pressure on the gland, or by obstructing the discharge of 

 the secretion of the posterior lobe through the infundibular stalk, may lead 

 to the symptom-complex. Furthermore, internal hydrocephalus, if of 

 a high grade, may by dilatation of the third ventricle lead to a similar 

 obstruction. Hence a condition of "cerebral adiposity" has been de- 

 scribed, due to hydrocephalus without a direct lesion of the 

 hypophysis. 



Obesity of hypophyseal origin often reaches high grades, and may 

 come on with great rapidity. It 'is characterized in the male by the pe- 

 culiar distribution of the fat, which is deposited especially about the 

 breasts, in the suprapubic region, in the abdomen and about the hips 

 and buttocks. This distribution, with the broad pelvis, knock-knees, and 

 feminine distribution of the pubic hair, gives a very characteristic appear- 

 ance to the patient. In the case of women with hypopituitarism the fat 

 distribution is of a similar type, but since this is usual in the ordinary 

 form of obesity in this sex, the appearance is less striking. 



Gushing has called attention to an extensive fatty infiltration of the 

 viscera, especially of the liver. 



The genital changes are striking and important. In both sexes there 

 is a hypoplasia. of the gonads, associated with lack of development of the 

 secondary sex characters. In the male the testes are small, the penis under- 

 developed and the pubic hair is of the feminine type. In the female the 

 ovaries, uterus and external genitalia remain in an infantile stage, and 

 the pubic hair is sparse. These changes are due to imperfect development 

 of the interstitial cells of the testis and ovary, which results in defective 

 internal secretion. The genital changes are therefore in the case of hypo- 

 pituitarism a secondary effect due to the loss of some substance elaborated 

 by the pituitary which stimulates the growth of the interstitial cells of 

 the gonads. 



The character of the genital changes depends upon the period at which 

 hypopituitarism sets in. If the onset occurs in childhood, lack of develop- 

 ment of primary and secondary sex characters occurs, with consequent 

 sterility ; if in adult life, amenorrhea, impotence and atrophy of the gonads 

 take place, while the external genitalia remain unaltered, except for 

 diminution of the pubic hair. 



Other signs of pituitary insufficiency (posterior lobe) are lowering of 



