CHAPTER XI 



PLURIGLANDULAR DISEASES 

 Multiple Ductless Glandular Sclerosis. Gigantism 



Already in the first chapter we pointed out how that in recent time 

 there has been a growing tendency especially in the French literature to 

 regard individual diseases of the ductless glands as pluriglandular diseases. 

 The number of contributions as to pluriglandular disease has shown a steady 

 growth. I have already stated my opinion that I regard this tendency as 

 mistaken. It must have the result that the individual typical disease pic- 

 tures will become more and more confused and that the laborious acquisitions 

 [to our knowledge] will again become lost in the general chaos. In order to 

 make manifest my viewpoint on this question, I would again briefly capitu- 

 late what I have already stated in detail in the first chapter as to the physio- 

 logical and pathological correlations. The disease of an individual duct- 

 less gland regularly has as a sequel disturbance in the other ductless glands, 

 that eventually may be recovered from if the gland primarily affected be- 

 comes healthy or if, for example, its absence of function [Ausfall] has been 

 made good by therapy (physiological correlations). By pathological cor- 

 relation I mean the phenomenon that the disease that has first involved one 

 gland involves, in its further course, other members of the ductless glandular 

 system. In the majority of cases, it may readily be seen what ductless gland 

 was first involved; for the most part indeed the disease of that ductless 

 gland stands so much to the fore, that in this case also I would rather avoid 

 the designation pluriglandular disease. Much more do I consider it cor- 

 rect to reserve this term for those cases in which the clinical picture shows 

 that the disease process embraces the whole ductless glandular system or at 

 least a large part of it. Multiple ductless glandular sclerosis must be des- 

 ignated as such a pluriglandular affection *<"' ox^v. In such cases we have 

 to deal with general symptoms of deficiency [of function, Ausfallerschein- 

 ungen] on the part of the system of ductless glands. 



The question as to whether the antitype exists, that is, if there occurs a 

 generalized hyperplasia of the ductless glandular system with corresponding 

 manifestations of increased function, seems to me not yet ripe for discussion. 

 There is no doubt that hyperplastic changes in the thyroid gland and in the 

 suprarenal cortex are not rarely a concomitant of acromegaly. But in 

 this case there is no occasion to doubt the diagnosis acromegaly on this 

 account. So much is the picture dominated by symptoms on the part 



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