890 WALTEK TIMME 



Baueiy Collard-IIuard, Cordier and Rebattu, Renon, Delille and Monier- 

 Vinard). 



Interpretation. In the variegated pictures presented by this syndrome 

 it is possible with a fair degree of accuracy to base the deficiency symptoms 

 upon the diminishing activity of special glands. Thus, the disappearance 

 of the secondary sex characteristics and the libido may be attributed to the 

 atrophy of the gonads and interstitial cells, and possibly the suprarenal 

 cortex. The loss of hair on the scalp, the changes in the teeth and many 

 of the other trophic disturbances together with the accompanying psychic 

 disturbances may be traced to thyroid insufficiency. It may be doubted, 

 however, whether the myxedematous characteristics can be wholly credited 

 to the thyroid disturbance, for the administration of thyroid extract does 

 not serve to eradicate them entirely. The polyuria and generally cachectic 

 condition are probably hypophyseal in origin, while the pigmentation, 

 hypotonus and asthenia are the result of suprarenal involvement (Wiesel 

 (a) (&)). 



Differential Diagnosis. Myxedema. While true myxedema is more 

 or less of an entity, the myxedematous characteristics of this syndrome 

 form only part of the picture and arise secondarily and much more slowly 

 than in pure myxedema. Furthermore, women are much more prone to 

 myxedema than men, whereas men are more frequently the victims of this 

 multiglandular disturbance. The nervous and mental symptoms in true 

 myxedema are much more pronounced and characteristic and dominate 

 the picture to a far greater degree than in this syndrome ; while the genital 

 disturbances are much less in evidence. The blood picture also differs in 

 the two conditions. The leucopenia with a relatively high lymphocytosis 

 seen in myxedema does not occur in this syndrome. The fact that the 

 administration of thyroid gland is only partially successful in combating 

 this syndrome compared with its striking results in pure myxedema is also 

 of great differential value. 



Addison's Disease. While pronounced pigmentation occurs in both 

 conditions, yet the disturbances of the hairy growth are almost never seen 

 in Addison's. Also, the rapid course of Addison's disease finds no counter- 

 part in this syndrome, the asthenia coming on much more slowly. 



Dystrophia Adiposogenitalis. No hypophyseal tumor is to be dem- 

 onstrated in the pluriglandular syndrome. 



Infantilism. In this condition, the body is small, the bony structure 

 is delicate, while the head is of normal size. In the pluriglandular cases, 

 there is no body disproportion and the appearance of senility in them 

 finds no counterpart in infantilism. The genitals do not resemble those of 

 children as being undeveloped but are developed structures which have 

 undergone atrophy. 



Thy mus-Adrenal-Hypophy seal Syndrome (Timme). In this con- 

 dition the process begins in infancy or very early youth and is based upon a 



