CLINICAL SYNDROMES 335 



or 27 per cent; amenorrhea was present in about half of these cases, 

 though menorrhagia was also noted. 



Pregnancy, Relation of Exophthalmic Goiter to. Pregnancy may take 

 place notwithstanding the existence of a moderate form of hyperthyroid- 

 ism. 



In fact, it is often rather beneficial than otherwise, though of course it 

 should not be recommended unless the condition of the patient is fairly 

 good and on the upward course. 



The Breasts. The breasts may show early hypertrophy in either sex 

 or they may look virginal in middle life. This hypertrophy may be 

 related to the lipomatosis sometimes present in other parts of the body 

 in Graves' disease. 



Nevertheless in the majority of cases the mammary glands are usually 

 more or less atrophic, Basedow reports a male patient with swollen, 

 hyperemic breasts, secreting colostrum. 



Libido and Potentia. These may both be lost in men. In both sexes 

 genital hypoplasia is not infrequently associated with exophthalmic goiter, 

 though always with a general involvement of the endocrin glands and 

 especially with hypopituitarism. 



Urinary Manifestations. Polyuria. Disturbances of urinary secre- 

 tion may occur ; polyuria is a frequent symptom but occasionally oliguria 

 may be noted. 



The polyuria may be explained by the increase in thirst and appetite, 

 but in some cases a neurosis or even diabetes insipidus have been con- 

 sidered the cause. 



Polliakuria or frequency of micturition may be quite troublesome in 

 the course of the disease. 



Albuminuria: The kidneys are rarely severely affected but albumi- 

 nuria with hyaline casts is usually present when the heart is much dilated. 

 Begbie and others have reported intermittent albuminuria of a consider- 

 able and sometimes an excessive degree. Murray found albuminuria in 

 six of thirty cases in which a urinary examination was made and con- 

 sidered it more frequent than glycosuria which occurred three times in 

 his series. 



Glycosuria will be discussed in a following section on alterations in 

 metabolism. 



Various Urinary Constituents; Relation of Exophthalmic Goiter to. 

 The urea and uric acid ammonia contents of the urine are the same as 

 in health. Acetone has been noted in small quantities by some observers; 

 large quantities occur when there is a relative deficiency of the carbo- 

 hydrate intake or after crises of vomiting and diarrhea. Indicanurm 

 does not occur, for marked putrefactive changes in the intestine are not 

 a feature of the disease. A retention of phosphorus has been noted by 

 Scholz corresponding to the gain in nitrogen. 



