OBESITY 39 



the body temperature, slow pulse rate, dryness of the skin, increased sugar 

 tolerance and drowsiness. 



The clinical picture is modified in cases due to tumor by the presence 

 of the signs and symptoms of this condition. Localizing signs may be 

 present, such as bitemporal hemianopsia. Enlargement or deformity 

 of the sella . turcica usually occurs in connection with tumor of the hy- 

 pophysis, and may be demonstrated in life by the Roentgen ray. A normal 

 or an abnormally small sella may be found 'in connection with primary 

 hypoplasia of the gland. 



The diagnosis of hypopituitarism should be suggested by the occur- 

 rence of obesity in the male with dysgenitalism and drowsiness, or in the 

 female when amenorrhea, sterility and an infantile condition of the sexual 

 organs are concomitant. In such cases a careful neurological examina- 

 tion should be made, including x-ray pictures of the sellar region. 



(3) Obesity of Genital Origin. Castration in the male, as shown 

 by Taiidler and Grosz, leads to precisely the same changes in the fat dis- 

 tribution as hypopituitarism, with pubic hair of the feminine type. The 

 epiphyses do not unite and an overgrowth in the bones of the extremities 

 takes place. A secondary enlargement of the pituitary ensues. General 

 obesity is frequent, but not invariable. The effect of castration in the 

 female, if performed in childhood, is to prevent the development of the 

 uterus and of the secondary sex characters. Partial eunuchism, a condi- 

 tion similar to that following castration, is met with occasionally as the 

 result of destructive disease of the gonads occurring before adolescence. 



The distribution of the fat differs also in another respect from that of 

 ordinary obesity ; it infiltrates the voluntary muscles. This is the reason 

 for castratipn among cattle, for it -improves the beef. 



(4) Obesity and the Pineal Gland. A high grade of obesity may be 

 associated with tumors of the pineal gland, as shown by Marburg. Such 

 cases are characterized by precocious sexual and genital development, 

 skeletal overgrowth, and the signs of a tumor in the region of the corpora 

 quadrigemina. Gushing points out that the adiposity might well be due 

 to the accompanying hydrocephalus with obstruction of the pituitary dis- 

 charge. 



(5) Obesity and the Adrenal Gland. A very similar clinical pic- 

 ture has been described in a rare type of adrenal tumor- occurring in child- 

 hood, in which there are obesity, skeletal overgrowth, pilosity, premature 

 sexual development and mental dulness. The symptoms are apparently 

 due to overactivity of the adrenal cortex, for in one case only a simple 

 hyperplasia of the gland was found. 



At this point a curious polyglandular syndrome should be mentioned, 

 in which enlargement of the salivary glands, and sometimes of the lacrimal 

 glands, is a conspicuous feature. The condition thus resembles the Miku- 



