44 WILDER TILESTON 



since he found in experiments carried out with Eckstein, that thyroidec- 

 tomized animals gained very rapidly in weight, largely owing to the re- 

 tention of water. This is in accord with previous work on the subject, 

 which has shown that the loss of weight following thyroid administration 

 is largely due to loss of water from the tissues. It is also possible that 

 disturbances of the pituitary gland play a part in some cases, as is sug- 

 gested by the abnormal water balance in diabetes insipidus and by the 

 remarkable effect of posterior lobe extract in controlling the excessive 

 diuresis of this condition. 



(2) Thyrogenous Obesity. In several cases a well-marked reduc- 

 tion of the basal metabolism has been noted. The most marked instance 

 is Hausleiter's third case, a girl of thirteen years, with a reduction of 

 28 per cent. The case was complicated by swelling of the salivary glands, 

 a syndrome to which attention has been directed above. No symptoms 

 of myxedema were present. Grafe's first case, a girl 16 years old, showed 

 a diminution of seventeen per cent, and presented a high grade of obesity, 

 with some traits of myxedema, and is therefore not a pure case of obesity. 

 It is of great interest as indicating the possibility of the combination of 

 obesity and myxedema, both due to disturbance of function of the thyroid 

 gland. McCaskey's sixth case, a girl 10 years old with hereditary 

 syphilis, showed a reduction of 15 per cent, without any symptoms of 

 myxedema. These are the only instances of thyrogenous obesity in the 

 literature in which a definite reduction of the basal metabolism has been 

 proven. There are other cases, however, in which the lack of response to 

 extreme restriction of the diet renders a lowering of the metabolism prob- 

 able. A good example is von Noorden's patient, a girl of 13 years, 

 weighing 55 kg. On an accurately determined diet of 800 calories, with 

 plenty of exercise, her weight remained constant. The continuous admin- 

 istration of thyroid extract, with a diet of 1500 calories, resulted in a 

 cure of the obesity. 



The effect of thyroid administration was very striking in Hausleiter's 

 patient, resulting in an increase of basal metabolism of 33 per cent, the 

 increase in the normal person varying from zero up to 15 per cent. 



(3) Hypophyseal Obesity. A definite reduction of the basal metab- 

 olism has been found in several cases, as may be seen in Table II. The 

 values have been calculated by several methods so far as possible ; the Har- 

 ris-Benedict formulas do not apply to children and adolescents. 



The figures in Means' cases have been recalculated according to the 

 tables of Aub and DuBois, which had not been published when his article 

 appeared. Two other cases studied by Means have not been included in 

 the table because the diagnosis of hypopituitarism was regarded as only 

 "probable." One of these, Mrs. L. L., showed a normal metabolism by 

 present standards ; the other, H. S., a diminution of eight per cent. 



A study of the table shows that in three cases out of six there is a 



