CLINICAL SYNDROMES 341 



Associated Endocrinopathies 



"While the interrelation of the various endocrin glands has recently 

 been the object of serious investigation, particularly by the younger Vienna 

 clinicians (Falta, Eppinger, Ruedinger and von Noorden, Jr.), "it must 

 be confessed that the theories as yet almost outnumber the facts," writes 

 Barker. Inasmuch as objective measurements could most readily be ap- 

 plied to changes in metabolism, it was to these processes that most of 

 their experiments were directed, in an endeavor to ascertain how far a 

 given hormone acts on the visceral nervous system and how far indirectly 

 through other endocrin glands. Their results and theories are sum- 

 marized in the accompanying diagram, which appears in their paper of 



1908. 



Thyroid 



Pancreas < > Chromaffin 



Inhibition system 



From this it will be seen that the pancreas and thyroid on the one 

 hand, the pancreas and the chromaphil system on the other hand, mu- 

 tually inhibit one another's activities. Again the thyroid and the chroma- 

 phil system reciprocally favor each other's activities a hypofunction or 

 a hyperfunction of the one gland leading to a hypo- or hyper-function 

 of the other. Hence hyperthyroidism must lead to an insufficiency of 

 the pancreas and to an increased activity of the suprarenals, while hypo- 

 thyroidism must lead to overfunction of the pancreas and a diminution 

 of adrenal activity. The Vienna school think that the glycosuria of 

 hyperthyroidism is an indirect effect through the chromaphil system and 

 that the hyperexcitability of the sympathetic nervous system as shown by 

 the epinephrin-mydriasis test, is to be similarly explained. 



The sympathicotonic cases of Graves' disease with the protrusio bulbi, 

 negative von Graefe, positive Loewi, and positive Moebius' signs, dry 

 eyeballs, marked tachycardia, dry skin, constipation, alopecia, slight fever, 

 eosinophilia and alimentary glycosuria, they attribute to thyrogenic hy- 

 peractivity of the chromaphil system. 



To explain the vagotonic cases, with the relatively slight tachycardia, 

 the marked subjective feelings of palpitation, positive von Graefe's sign, 

 wide lid-slits, negative Moebius' sign, slight or absent protrusio bulbi, 



