THE SYMPATHETIC SYSTEM 25 



II. THE CLINICAL ENDOCRINE SYNDROMES. 



In spite of the frequency of endocrine disturbances, very 

 often their existence and significance is misunderstood. 

 As time goes on, new methods spring up to help us locate 

 and identify them. In these introductory pages, it is not 

 amiss, after having shown the complexity of altered 

 endocrine functions, to show the influence exerted by the 

 sympathetic and to recall the facts which the clinician 

 must base himself on, in order to reach a diagnosis and treat 

 the case. 



We must keep in mind the various types of lesions which 

 give rise to endocrine symptoms. Next to the cases with 

 mild lesions, we have others which are quite severe. The 

 clinical interpretation and therapeutic application of the 

 facts must be very different. 



In certain cases there is a congenital lesion; for in- 

 stance, when there is agenesis of the thyroid, resulting in 

 myxedema or cretinism. More often we have to deal with 

 acquired lesions: neoplasm or inflammations. The neo- 

 plastic lesions may vary considerably; they may be benign 

 without any other importance than their location, such as, 

 the colloid goitres, certain adenomata of the pituitary or 

 of the adrenals. They may be epithelial or sarcomatous 

 lesions, as have been reported in the thyroid, the adrenals 

 or the pituitary ; to the symptoms associated with destruc- 

 tion of the gland, may then be associated those resulting 

 from hypertrophy of the affected organ. Furthermore, the 

 malignant tumor may show signs of cachexia due to 

 the secretions (certain cancers of the thyroid). 



The histological study of a great number of benign or 

 severe tumors has shown the part played by the hyper- 

 plasia of the organ, more often dyshyperplasia than 

 true hyperplasia and the resulting abnormal secretion, 



