Multiglandular Syndromes 



WALTER TIMME 



NEW YORK 



Introduction 



Definition. Multiplicity of Features. When one considers the inter- 

 relation and interdependence of the units of the internal glandular system 

 it is hardly conceivable that there should be any absolutely uniglandular 

 disturbance. And so it becomes necessary to offer some explanation that 

 the title of this chapter is designed to cover only a very limited portion of 

 the many endocrinous conditions. It is much more simple to do this 

 than to offer a formal definition of the term "pluriglandular disturbance" 

 as distinct from a uniglandular disturbance." And so let it be agreed at 

 the outset that by uniglandular disturbance is meant such a pathological 

 condition as may be produced by the disturbed activity of a single gland 

 primarily, however many of the other glands may be called into sub- 

 ordinate play ; but furthermore that the resulting syndrome be composed 

 almost entirely of the manifestations of this particular gland's dysfunc- 

 tion, overshadowing the effects of the disorders of the subordinates. Addi- 

 son's disease and myxedema offer examples of this type. Exophthalmic 

 goiter is usually considered also as of this class, although the evidence of 

 late years is gradually assigning it to the pluriglandular group of endocrin 

 disorders. 



A pluriglandular syndrome might then be stated to consist of a 

 group of symptoms and physical signs produced by disturbances of the 

 glands of internal secretion in which either synchronously, alternately or 

 consecutively, the manifestations of the various disturbed units make their 

 appearance. 



The whole aspect of multiglandular syndromes is more or less confus- 

 ing at the present stage of our knowledge. If the disturbances in one 

 gland are accompanied practically always by disturbances in all the others, 

 why is it that these secondary manifestations, providing the initial gland is 

 the same in every case, are not always similar and that the resulting pic- 

 ture is not always more or less in conformation to a type? Why is it 

 that a diabetic mother should give birth to a child with exophthalmic goiter 



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