IV. The treatment with gonadotropic hormone (anterior pituitary-like) of nonadipose boys showing genital dystrophy

Summary 1. The meager reports in the literature on the response to hormone therapy of preadolescent, nonadipose boys with genital dystrophy, has prompted the writer to report upon two such boys showing genital dystrophy without obesity, who were treated with hormone therapy, namely, anterior pituitary-like hormone of pregnancy urine. 2. It is the opinion of the writer that the greater number of nonadipose boys with genital dystrophy, as well as adipose boys with genital dystrophy, usually show an endocrinologic basis for their genital disturbance. The writer has found from his experience actually only very few cases with genital dystrophy and no apparent endocrine involvement at the time. 3. Obesity in itself in these patients did not indicate that the case was or was not endocrine in nature. Rather, other more pertinent factors, such as mental, physical, somatic, or osseous deficiencies, were considered the criteria significant in determining whether the cases were endocrine, and in determining which was the primary offending gland involved. 4. In the two cases reported here, the primary offending gland responsible for the mental, physical, and genital disturbances was believed to be the thyroid gland. Therefore, a diagnosis of primary hypothyroidism with secondary involvement of the genitals was made. 5. With the use of proper and judicious hormone therapy, the nonobese boys with genital dystrophy responded favorably. 6. Of the various hormone preparations administered, the following results were noted: a. Anterior pituitary-like hormone extracted from pregnancy urine produced the best results. b. A gonadotropic hormone extracted from the anterior pituitary gland showed some gonadal stimulative properties. c. Anterior pituitary-like hormone extracted from the placenta showed no stimulative effects on the gonads of the one boy treated with this preparation. d. Desiccated thyroid administered to correct the hypothyroidism in hypothyroid patients showing genital dystrophy was found in cases of another series, in addition to other effects, to have stimulating effects upon the gonads. This gonadal stimulation, however, was less marked and much slower in its action than the stimulation with anterior pituitary-like hormone of pregnancy urine. Therefore, for more direct and rapid stimulation of the gonads, anterior pituitary-like hormone of pregnancy urine, rather than desiccated thyroid, was used to overcome the genital dystrophy. 7. For the correction of some of the other endocrine deficiencies as the mental, physical or osseous retardation noted in many patients in addition to the genital dystrophy, further therapy, such as desiccated thyroid, was found necessary. This is being given at this time in the cases reported here. 8. Since at the present time there is no definite way of determining beforehand when a patient will not respond to proper hormone treatment (although it is my opinion that the greater number of cases of genital dystrophy will respond to hormone therapy), it is advisable to institute such therapy in all cases of genital dystrophy, with the exception of cases of normally developed aberrant (ectopic) testicles. Then, after judicious hormone therapy has been administered without results, surgery for the correction of a likely mechanical obstruction should be considered. If surgery is feasible, then afterward proper endocrine therapy should be resumed in order to provide the necessary gonadal stimulation.