868 AUGUST STRAUCH 



J 



organ or with the disappearance of the myxedema under specific organo- 

 therapy the gonads and suprarenals resume approximately their normal 

 function. In atypical cases of spontaneous myxedema, Addison's disease, 

 or late eunuchoidism, however, the anatomico-pathological process itself 

 may, to a certain degree, involve also other glands. These forms present 

 transitions to those of pluriglandular disease in which a serious primary 

 anatomical process, namely hypoplasia, or inflammatory sclerosis and 

 atrophy affect several or all glands more or less simultaneously; the thy- 

 roid, genitals, hypophysis and suprarenals especially participate, though 

 other structures also may be involved, as the parathyroids, the pancreas, 

 liver and kidneys. 



The complex clinical picture to which Claude and Gougero in their 

 fundamental essay on "insuffisance pluriglandulaire endocrinienne" have 

 directed our attention, is therefore characterized principally by the com- 

 bination of signs of hypothyreosis, hypophysial deficiency, eunuchoidism 

 and morbus Addisoni with progressive cachexia, as exemplified by the 

 instructive case of the two authors and by a number of observations of 

 others. The progressive cachexia, for which the sclerosis of the pituitary 

 body is partly responsible, probably prevents the otherwise expected hy- 

 pophysial adiposity in the clinical picture. 



As the associations of pluriglandular insufficiency are numerous and 

 of different degrees, it is evident that there exist a series of syndromes 

 that vary according to the glands affected, the degree and succession of 

 the disorder of each individual ductless gland, and the age of the person. 

 While in the adult retrogressive symptoms develop as discussed in another 

 chapter, in the young and congenital cases, multiglandular derangement 

 must needs result in formal infantilism with retardation or cessation of 

 growth, as the growth controlling organs are involved. The formation of 

 eunuchoid long-leggedness as due to the effect upon the skeletal develop- 

 ment of the failure of goiiad function, however, may be entirely counter- 

 acted by the simultaneous hypophysial inactivity. Pluriglandular sclero- 

 sis has been observed associated with or resulting from tuberculosis, hies, 

 possibly alcoholism or following acute infectious diseases; it may also 

 appear spontaneously as a seemingly independent disease of rather obscure 

 origin. Claude and Gougero assume a congenital debility of the endocriii 

 system for such cases, liable to degeneration under the influence of a not 

 well definable noxa. 



That pluriglandular insufficiency during the growing stage may be of 

 only transitory nature is evident from the observation (No. 54) of Falta. 

 The patient, J. K., 17 years old. He had typical tetany and epileptic 

 attacks ; was of medium size; the skin was dry and the face and hands myx- 

 edematous. Hairs of the beard, in the axilla, linea alba and on calves 

 were absent ; there was scanty hair at the root of the penis. The testicles 

 were very small; he had no libido, erections or pollutions. The finger 



