Case report of a castrate

[spadone (imported)]

McCullagh and Renshaw, JAMA 101(15) 1140, 1941.

REPORT OF CASE

A married man, aged 33, had a bilateral orchidectomy in 1925 for tuberculosis orchitis. Following the operation signs of pulmonary tuberculosis developed but there has been no activity of the pulmonary disease since 1929. After the operation libido was greatly diminished but sexual potency, although diminished, persisted and he had been capable of intercourse every two to three weeks. He had a normal climax of sensation and the rhythmic contraction but he believed that ejaculation did not occur. There had been considerable atrophy of the penis. Shortly after the operation he began to have severe hot flashes several times daily associated with nervousness, sweating and fatigue. Before 1925 he had weighed about 150 pounds (68 Kg.). Since the onset of the tuberculosis he had gained steadily. In March 1932 he weighed 174 pounds (79 Kg.). The increased fat was distributed chiefly about the breasts, abdomen and hips, as shown in the illustration. The scalp hair remained normal, and the beard growth may have been retarded somewhat. According to the patient’s statement, the limbs and torso had previously been hairy, but within a year after castration hair on the body had practically disappeared.

At examination the patient was alert and cooperative. His skin was sallow, dry and of fine texture and showed peculiarly fine wrinkles. The scalp hair was normal and the beard tended to be slightly scant. There were a few short sparse hairs about the nipples and the axillae, and the pubic hair was scant and the distribution was of the feminine type. The examination of the eyes revealed the presence of the physiologic cup and ring; the lamina cribosa sclerae was not seen. There was some retraction of the disks upward and outward. A slight parifibrosis was seen in both eyes but in the opinion of the ophthalmologist there were no significant changes. The visual fields were normal. There was a palpable, smooth, diffuse enlargement of the thyroid, two to three time the size of the normal gland. There was no sign of activity of the pulmonary tuberculosis. The scrotum was empty and the penis smaller than normal. The prostate was from one-fourth to one-fifth the usual size. It was flat and solid but poorly defined. Vigorous massage failed to express any secretion.

The pulse rate was 80 and the blood pressure 120 systolic, 72 diastolic. A roentgenogram of the chest showed old healed tuberculosis. Roentgenograms of the sella turcica showed us no abnormality. The basal metabolic rate was minus 16 percent. Urinalyses, blood counts, and Wassermann reactions were normal. The dextrose tolerance was increased. Blood sugar estimations fasting and at the end of one-half hour, and at intervals of one, two, three and four hours after the oral administration of 100 Gm. of dextrose were 80, 116, 98, L, 65 and 75 mg. per hundred cubic centimeters. The blood cholesterol was high, 250 mg. per hundred cubic centimeters. Otherwise, chemical analyses of the blood for urea, uric acid,

creatinine, nonprotein nitrogen, chlorides, calcium, phosphorus, proteins, albumin and globulin showed no deviation from normal.

The Friedman test showed that there was an excess o gonad-stimulating principle in the urine. Bloassays of the blood and urine failed to reveal any male sex hormone.

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