CLINICAL SYNDROMES 345 



Hypophysis Cerebri, Disorders in Function of. Acromegaly may 

 complicate Graves' disease according to both Ballet and Holmgren (a). 

 Walsh (b) has also recently reported a case of atypical acromegaly in a 

 woman with exophthalmic goiter associated with a congenitally high fore- 

 head. From the history it would seem that the acromegaly antedated the 

 hyperthyroidism by many years as the former was present for some years 

 before the sudden development of the latter, after a severe mental shock. 



MacCallum (&) found no evidence of disease in the one case in which 

 he investigated the hypophysis. 



Hofstaetter in an excellent paper points out that some of the symp- 

 toms of exophthalmic goiter can be better explained by an injury of 

 the hypophysis than by a hyperf unction of the thyroid gland: for ex- 

 ample, the fever, the polyuria, polydypsia, some of the trophic dis- 

 turbances, the fat deposition, the insomnia and the occasional increase 

 in growth. Further, he believes that the phenomena which are usually 

 assigned to an increased epinephrin output can be explained by the hy- 

 pophyseal influence. The results of hypophyseal therapy all speak for 

 a hypofunction of the gland in exophthalmic goiter. The belief of Salmon 

 that the hypophysis plays the chief role in the etiology of exophthalmic 

 goiter does not seem tenable to Hofstaetter, for the hypophyseal are not the 

 chief symptoms, nor does hypophyseal therapy benefit the cardinal symp- 

 toms, Animal experiments suggest that part of the benefit when hypophy- 

 seal extract is given therapeutically to man is to be referred to the associated 

 hyperepinephrinism. He believes that the hypophyseal pathology is not 

 the cause but one of the very early results of the dysthyroidism. 



Suprarenal Disorders. There seems to be little doubt that many of 

 the symptoms of Graves' disease can be assigned to an affection of 

 the adrenal glands, namely, the pigmentation, weakness, diarrhea and 

 the positive Loewi phenomenon. Further, some cases of co-existence of 

 Graves' disease and Addison's disease have been reported by Eulenburg 

 and Oppenheim. The latter's case, in addition to pigmentation of the 

 skin, had a pigmentation of the bulbar conjunctive and mucous mem- 

 branes of the lips, as well as a marked asthenia. Fraenkel has shown 

 that the blood of three well marked cases of Graves' disease contained 

 four to eight times the amount of adrenalin that the normal controls 

 revealed and that, in spite of an absence of evidence of hypertonus. 

 The actual figures were 50 to 100 milligrams in the total blood stream 

 of the exophthalmic goiter cases as compared with the normal 12.5 

 milligrams. It would suggest that the function of the adrenals may be 

 both stimulated and depressed in different stages of the*disease. 



Simmonds (a) as well as 'Hedinger have noted hypoplasia of the 

 chromaphil system in cases of exophthalmic goiter and status thymolym- 

 phaticus. 



Matti found that the suprarenals in one of his cases were smaller 



