OVARIAN INSUFFICIENCY 177 



removed, the cysts in the breasts, for which an operation 

 had been planned, rapidly disappeared. 



Apart from the natural and artificial menopause, insufficiency 

 insufficiency of ovarian secretion, with or without secretion 1 

 climacteric symptoms, may occur in various pathological a P art from 

 conditions. When the insufficiency is temporary there pause. 

 are usually no untoward symptoms, but when it is 

 permanent menopausal symptoms, usually mild, gener- 

 ally supervene. 



As we have already seen, there may be congenital 

 ovarian insufficiency which leads to primary amenorrhcea 

 and reproductive incapacity; this is rare, and is almost 

 always associated with general somatic underdevelopment 

 (see p. 158). Novak 1 asserts that primary ovarian 

 insufficiency is never seen except with general ateleiosis. 

 Such an assertion is, however, too sweeping. 



After puberty insufficiency may arise as the result 

 of disturbances of the other organs of internal secretion, 

 such as pituitary disease. In the condition known as 

 dystrophia adiposogenital the effect is direct: insufficiency 

 in the anterior lobe of the pituitary produces ovarian 

 hypoplasia. In acromegaly, on the other hand, the 

 effect is indirect, and is due to the production of 

 masculinity. 



It has been stated by some authors (Freund 2 , 

 Verstraeten 3 and others 4 ) that ovarian insufficiency is 

 the primary cause of pituitary disease, but we have no 

 real evidence that this is so. My experimental results 

 point to an opposite conclusion — namely, that ovarian 

 insufficiency follows pituitary disease. 



In the living subject it is always a difficult matter 

 to know whether genital inactivity — such as is indicated 



1 Novak, J., Erhranh. des Weiblichen Genitales, Supplemerite, 1912, 

 vol. i, p. 539. 



2 Freund, H. W., Volkmarfs Klin. Vortr., 1889, Nos. 329 and 330, 

 quoted by Biedl, Inner e SeJcretion, 2nd ed., 1913. 



3 Verstraeten, C, Rev. de Med., 1889, vol. ix, pp. 377 and 493. 



4 Tandler, J., and S. Grosz, Wien. Klin. Woch., 1907, vol. xx, 

 p. 1596. 



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