SYNDROMES INVOLVING THE PINEAL GLAND 53 



plies to all cases alike, no matter what the age of onset. We now come to 

 that special class of symptoms which may be called constitutional or meta- 

 bolic, which are supposed to be related to a disturbed secretion of the cellu- 

 lar elements of the pineal itself. These symptoms occur only in children 

 before the age of puberty. The question as to whether they represent an 

 over- or an underactivity of secretion has been discussed by numerous 

 writers. Those who believe that the changes are due to overfunctioning, 

 base their ideas on the fact that sometimes, in other conditions, tumor 

 cells elsewhere in the body have been found to take on and elaborate the 

 function of the organ involved. These writers also point to the fact that 

 certain investigators have produced a hastened maturity and physical 

 growth, by feeding pineal gland substance to animals (Dana and Berkeley, 



McCord(a.))- 



On the other hand, there is considerable evidence that the constitu- 

 tional manifestations of hastened maturity in children with pineal disease 

 is due to underactivity. First, it is known that normally at the age of 

 puberty the pineal undergoes atrophy. Second, in the reported cases of 

 children showing the so-called pineal syndrome, tumors replacing the 

 pineal were found at autopsy. Third, experimental extirpation of the 

 pineal in young animals has been shown by some investigators to hasten 

 sexual maturity (Foa(c), Sarteschi ( b ) , Horrax). Dandy, however, in a 

 series of experiments upon young dogs was unable to detect any constitu- 

 tional manifestations. 



Whatever the status of secretory activity of the pineal cells or whether 

 they have any activity at all, we know from the case reports, in which 

 data on this subject are included, that a fairly definite clinical syndrome 

 occurs in children prior to the age of puberty, in whom at postmortem 

 examination a tumor of the pineal has been disclosed. This syndrome has 

 been given the name "macrogenitosomia-precox," and consists for the most 

 part in a greatly hastened maturity both of body and mind, with an espe- 

 cially early and pronounced activity in the realm of both primary and 

 secondary sex characteristics. The individual manifestations may be 

 taken up further in detail. 



Individual Manifestations 



Bodily Overgrowth. A general and rapid growth of the whole bodily 

 frame is one of the most usual and evident findings in the clinical picture. 

 Oestreich and Slawyk mention that their patient when four years old 

 measured 3 feet G 1 /^ inches^ which is almost 6% inches more than ideal 

 height for the age. V. Frankl-Hochwart's patient measured 4 feet % 

 inch at the age of 5% years, a height which one would expect of a boy of 

 nine. In the case reported by Raymond and Claude, the subject at ten 



