MULTIGLANDULAR SYNDROMES 891 



presumably disturbed thymus function, as contrasted with the syndrome 

 under discussion. Myxedematous characteristics practically never appear, 

 and falling out of hair is not recorded. There is deficiency of hair ab 

 initio. The thymus-adrenal-hypophyseal syndrome is a more or less com- 

 pensatory one, the patients after a protracted siege, extending over one or 

 more decades, going to cure, as contrasted with those under discussion who 

 become progressively worse and in whom treatment is only of partial avail 

 in slowing the process. 



Therapy. As is indicated throughout the discussion of this disease 

 process, therapy is only of partial avail with but temporary effect. Thy- 

 roid administration serves to mitigate the myxedamatous symptoms. 

 Mixed glandular therapy of course in all degrees and combinations has 

 been attempted, with but little reported success. Serum of thyroidec- 

 tomized goats has been said occasionally to effect some improvement. 



Pathology and Pathogenesis. A number of cases of this plurigland- 

 ular insufficiency have come to autopsy (Sour del) . With great uniformity, 

 there have been found in the glands suspected clinically processes of con- 

 nective tissue hyperplasia scleroses findings that explain their dys- 

 function during life. The glands implicated were chiefly the thyroid, 

 gonads, hypophysis and adrenals. The sclerosis determined a definite 

 functional lack, for large areas of the parenchyma of the several struc- 

 tures had degenerated. In the thyroid, frequently tuberculous nodules 

 with connective tissue proliferation were seen. Occasionally in liver and 

 pancreas also a chronic interstitial productive inflammation was manifest. 

 Many theories of course endeavor to account for this connective tissue di- 

 athesis. Wiesel believes that possibly one particular gland bears the same 

 relation to this interstitial process as does the pituitary to fatty deposits, 

 and that this gland is in all probability the thyroid ; for, as in our experi- 

 ence cirrhotic processes are never seen in hyperthyroidism, their presence 

 in subthyroid activity argues strongly for the contention that thyroid 

 deficiency must bear the responsibility for their production. 



2. Thymus-Suprarenal-Pituitary Compensatory 

 Syndrome (Timme) 



Definition. This syndrome differs from the pluriglandular insuffi- 

 ciency of Claude and Gougerot. For, although in the latter remissions 

 and stationary stages are described, the various subtypes of the pluri- 

 glandular syndrome of Claude and Gougerot are all progressive. The 

 general evolution of the disease is characterized by the downward tendency 

 of the patient towards death through progressive asthenia or mtercurrent 

 disease. The syndrome now to be described is one that only exceptionally 

 follows a downward course even though its activity is manifested through- 

 out several decades. While absolute recovery in the sense of a full restora- 



