168 



THE SEX-COMPLEX 



Pituitary 

 lesions and 

 derange- 

 ments of sex- 

 character- 

 istics. 



Pluri- 

 glandular 

 lesions in 

 derange- 

 ments of the 

 sex-character- 

 istics. 



exhibits masculine characteristics : the heavy features, 

 the coarse skin, the deep voice at once attract our 

 notice. Yet this alteration of sex-characterization does 

 not appear to have been recorded as such until recently 1 . 

 But the alteration may go further than the phenomena 

 mentioned above, which are constant : amenorrhcea is 

 nearly always seen ; and this is not primarily due to 

 hypoplasia of genitalia but to the general change towards 

 masculinity, in association with which menstruation 

 would be anomalous. 



Buday and Iansci 2 , Cushing 3 and Goetsch 4 have 

 stated that in men the onset of acromegaly is not 

 infrequently associated with increased sexuality. This 

 probably indicates increased masculinity. 



There is no doubt that in women hypoplasia of the 

 pituitary (dystrophia adiposogenitalis) leads to decreased 

 function in the ovaries, consequently the apparent 

 paradox of amenorrhcea with increased secretion in 

 the anterior lobe of the pituitary can only be explained 

 on the ground of the production of masculinity in 

 these circumstances. If further evidence than that 

 mentioned of the production of masculinity in women 

 with acromegaly were required it would be found in one 

 case which came under my notice : in this patient the 

 clitoris was enlarged to the size of a small penis. 



We must, of course, always bear in mind the fact that 

 in diseases of the internal secretory system there may be — 

 indeed, there usually is — what is called a pluriglandular 

 syndrome ; that is to say, more than one organ of 

 internal secretion is affected. So it might be suggested 

 that in acromegaly there may also be hyperplasia in the 

 suprarenal cortices, and that it is the latter condition 

 which is responsible for the masculinity in this disease. 



1 Bell, W. Blair, Arris and Gale Lectures, Lancet, 1913, vol. i, 

 p. 937 ; and Proc. Roy. Soc. Med. (Obstet. and Gyncecol. Sect.), 1913, 

 vol. vii, p. 47. 



2 Buday, K., and N. Iansci, Deutsch. Archiv. /. Klin. Med., 1898, 

 vol. lx, p. 385. 



3 Cushing, H., The Pituitary Body and Its Disorders, 1912. 



4 Goetsch, E., Bidl. Johns Hopk. Hosp., 1916, vol. xxvii., p. 60. 



