Sexual precocity, always of interest to the clinician, has become increasingly so of late, because of a more thorough appreciation of the causative factors. Notwithstanding the progress made in this field, there are still cases of precocity associated with lesions of the brain which require further elucidation. Particularly is this true of that type of precocity associated with lesions in the hypothalamic region or with lesions of the brain which are accompanied by chronic increased intracranial pressure and which produce their effects through some disturbance in the hypothalamic-hypophysial mechanism, without producing the ensuing typical lesions in the endocrine glands one generally associates with sexual precocity.Although some clinicians may doubt that there is any connection between such lesions of the brain or intracranial pressure and their effects on the hypothalamic-infundibular-hypophysial pathway and precocity, others have hinted at the possibilities of such lesions in association with involvement of the pituitary gland. Heuyer, Le Marquand and others have considered the likelihood of such derangement of the pituitary gland in the following cases : Heuyer and his co-workers,1 in 1931, presented the case of a boy From the

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The more important features to be presented here are: 1. There is definite proof that the retarded osseous development in congenital sporadic cretinism has its origin in utero.2. There is an apparent relationship of this osseous retardation to a disturbance of the thyroid gland in the fetus.3. Two additional cases of cretinism in one of differently sexed fraternal twins are reported, with roentgen demonstration of the occurrence of osseous retardation in utero in one case.4. The probable deductions that may be made in the physiology are discussed. North America. In his series he cited one case reported by Charles Herrman,2 in male twins, 6\m=1/2\years of age, one twin being normal. Another, though rather atypical, case was reported by Manson,3 a case of myxedema in both brothers, aged 113/2 years. Petschacher * also briefly reported the occurrence of myxedematous cretinism in 14 year old twins.As far as I know, retarded osseous development occurring in utero, however, has never been demonstrated in congenital sporadic cretinism, although both Engelbach " and Shelton°mentioned it as an aid for the early recognition of congenital cretinism.

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