202 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



current pneumonia, the myxoedema itself being in a mild and 

 early stage? 1 The changes found in the thyroid gland were 

 of two kinds, namely: interstitial inflammation 32 and pure 

 atrophy. In the above case there were found an atrophy of 

 the pituitary (its size being three-fourths that of the normal) 

 and a marked involvement of its blood-vessels. Some parts 

 of the thyroid gland showed a marked colloid change. On 

 examination of the pituitary body an almost complete loss of 

 the glandular substance was found, together with marked in- 

 duration of the fibrous stroma, and the resemblance between the 

 pathological changes in the two glands was striking. The post- 

 mortem examination in the second case also showed destruction 

 of the glandular elements of the pituitary and a growth, in 

 its stead, of fibrous tissue. Ponfick observed that these and 

 other recorded cases go far to show that in a good many cases 

 of myxcedema where a considerable portion of the thyroid may 

 be found intact the hypophysis is so changed and its glandular 

 substance so much destroyed that it seems probable that the 

 morbid changes had begun in the hypophysis before there were any 

 alterations in the thyroid body." 



The sequence of events is clearly indicated in these cases. 

 But why did they not give an early history of acromegaly? 

 For the same reason that some cases of exophthalmic goiter 

 lapse into the second, or cachectic, stage soon after the onset 

 of the first: i.e., because their suprarenal glands were mor- 

 bidly inadequate, rapidly yielded, and became insufficient 

 through the combined effects of the thyroid and pituitary se- 

 cretions which their own overactivity had brought on. Once 

 overnourished for any length of time, the tendency of tissue 

 is not to resume its normal histological organization, but to 

 degenerate, as is well shown in the case of the heart-muscle. 

 All three organs, therefore, underwent retrograde metamor- 

 phosis. This is proven by the fact that the progress of either 

 disease is not impeded when the three organs involved in such 

 cases are adequate and able to withstand for a sufficiently long 

 period, and simultaneously, a high grade of overstimulation. 

 The typical syndrome of thyro-suprarenal overactivity, exoph- 



81 All italics are our own. 



82 Doubtless due to the toxic process. S. 



