34 8 INTERNAL SECRETION 



investigation which is open to us, is to start with the known 

 results of the functional derangement of any organ, and, by 

 following these up, to seek the primary link in the pathological 

 chain. 



The scantiness of our knowledge concerning the function of 

 the hypophysis and the experiments which have been undertaken, 

 largely without success, with the object of determining the scope 

 of the hypophysal function in animals, probably account for the 

 fact that, in clinical conditions associated with changes in the 

 hypophysis, other internal secretory organs (thyroid, thymus, 

 sexual glands, pancreas, suprarenal) have always been accredited 

 with an equal and simultaneous participation. This was the 

 origin of the polyglandular syndrome of the French authors. 

 Under the designation insuffisance pluriglandulaire, Claude and 

 Gougerot (1907) described a symptom complex which they 

 assumed to result from the general atrophy and functional insuffi- 

 ciency of a number of internal secretory organs. Since then, a 

 number of similar cases have been described. That we have not 

 to do here with a well defined clinical entity is shown by the fact 

 that the functional derangement, in either the positive or negative 

 sense, of one organ is not by any means always followed by 

 corresponding changes in the activity of other organs of the 

 group; for it more often happens that the hyperfunction of certain 

 internal secretory organs is associated with hypofunction on the 

 part of others, and vice versa. As a matter of fact, cases have 

 been described in which polyglandular insufficiency was associated 

 with either hyperpituitarism or with hypopituitarism (Delille). 



The formulation of a separate clinical entity of polyglandular 

 origin, appears upon the whole to be premature. There is no 

 doubt that clinical observation and experimental research will 

 shed a good deal of light upon the interrelationships between the 

 different internal secretory organs ; but until experimental investi- 

 gation is put upon a sound physiological basis, we cannot hope 

 for any certain illumination of the pathogenesis of the newer 

 clinical types. 



THEORY OF THE FUNCTION OF THE HYPOPHYSIS. 



The study of the morphology, physiology and pathology of 

 the hypophysis has supplied a good deal of information concerning 

 the functional significance of that organ, but up to the present it 

 has not sufficed to create a definite and finished picture of its 

 physiological activity. The best that we can do is to draw from 

 the facts at our disposal an approximate conclusion concerning 

 the nature of the hypophysal function. 



Morphologically, the hypophysis appears to be an organ com- 

 posed, both genetically and structurally, of two entirely different 

 portions. The anterior lobe may justly be regarded as a secretory 



