DERANGED SEX-CHARACTERISTICS 169 



According to Cushing 1 , hyperpituitarism (acromegaly) Piuri- 

 is often associated with a low blood-pressure, asthenia fesions fn 

 and pigmentation — symptoms which indicate insuffic- dera £ge- 

 iency of the suprarenal medulla. Indeed, I have sex-character- 

 myself seen a case of acromegaly which also presented ls 1CS ' 

 all the symptoms of Addison's disease. But it must 

 not be forgotten that hyperplasia of the suprarenal 

 cortex might be associated with insufficiency of the 

 medulla (Addison's syndrome), even if we accept the 

 view that the two portions are interdependent. An 

 interesting case is recorded by Anderson 2 in which 

 hyperplasia in the left suprarenal (fig. 56) was found in 

 association with an adenomatous chromophobe tumour 

 (fig. 57) in the pars anterior of the pituitary of a woman 

 aged 28 years, in whom certain male characteristics had 

 developed. A complete post-mortem examination was 

 made. The author states that the anterior lobe was in 

 a state of increased activity, and this is certainly borne 

 out by the appearance of the chromophobia present 

 in the cells of the pars anterior, apart from the tumour. 

 The uterus was atrophied (fig. 58), and so were the 

 ovaries (fig. 59). Somewhat similar cases have been 

 recorded by Cushing 1 and others. In these circum- 

 stances we would expect male characteristics to be 

 produced by both lesions, with atrophy of the female 

 genitalia, as was found in the case described. Never- 

 theless it appears to me certain that acromegaly alone 

 may give rise to a change in the secondary characteristics 

 of the female towards the masculine type. 



So far as I am aware, no cases are on record in 

 which pineal tumours have led to the development of 

 masculine characteristics in adult women, although on 

 the evidence at our disposal such an occurrence might 

 be expected. 



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



2 Anderson, J., Glasgow Med. Journ., 1915, vol. Ixxxiii, p. 178. 



