* 422 NELSON" W. JANNEY 



bid nervous phenomena should suggest true idiocy, signs limited to bone 

 and cartilage involvement, rickets and chondrodystrophy, etc. 



It seems timely to mention, in this period of scientific development of 

 infant feeding, that while morbid conditions of the intestinal tract are 

 receiving as a cause of underdeveloprnent just attention from pediatricians, 

 the influence of insufficient thyroid function upon normal growth may be 

 overlooked. The same holds true for the food deficiency diseases. Per- 

 haps the wisest course to pursue in difficult cases is to immediately estab- 

 lish an unquestionably proper diet for a given case of failure of develop- 

 ment, then only to seek for a possible endocrin factor in the case. 



The relative frequency of hypothyroidism of the masked type leads 

 the writer to mention the possible confusion with the status lymphaticus 

 or liypoplasticus. The status lymphaticus is characterized by hyperplasia 

 of all lymphoid tissues including the thymus, vagotonia at times, cardiac 

 vascular hypoplasia, lymphocytosis, retardation of sexual development and 

 liability to infections and sudden death. Although the Wiesel's and Hed- 

 inger's (a) studies have connected the status lymphaticus with defective 

 development of the chromaffin tissue of the suprarenal glands, it may be 

 pointed out that many symptoms ascribed to status lymphaticus occur also 

 in hypothyroidism. The lymphatic hyperplasia, though not so marked, 

 is usually present in subthyrold children, also hypoplasia of the cardio- 

 vascular and genital tract and at times vagotonic symptoms. 



Diagnosis from other Endocrin Dystrophies is not infrequently re- 

 quired in atypical cases. Of such, hypopituitarism may present certain 

 similarities, stunting of growth, obesity, mental dullness, weakness, de- 

 pression of the basal metabolism. 



Frolilicli's syndrome is, however, usually distinguishable through the 

 pituitary typo of limbs and hands, the marked developmental delay of the 

 primary and secondary sexual characteristics and the feminine fat dis- 

 tribution usually confined to the parts between the waist and juncture of 

 middle and lower thirds of thigh. Abnormalities in the rontgenogram of 

 the pituitary fossa, accompanied by the symptoms and signs of intracranial 

 pressure arc important when present. The ossification is not so markedly 

 retarded as in hypothyroidism. Involvement of the thyroid may, however, 

 be present in hypophyseal conditions and vice versa. For example, Joseph- 

 son's case of congenital thyroid adenoma developed hyperplasia of the 

 pituitary. See also writer's case illustrated in this article. Clinical lab- 

 oratory h>sts at present afford, unfortunately, no exact criterion for differ- . 



tiaUiagnosis between the various endocrinopathies. Indeed, the general 



experience thus far acquired in this regard suggests a general similitude of 



The basal metabolic rate is decreased both in hypopituitarism and 



lypothyroidism. If, however, the metabolism is depressed below minus 



ondition is very probably hypothyroidism 

 Eunuchvidism only resembles hypothyroidism in the retardation of the 





