M ! I LTIGLANDF L A R SYNDROMES 



805 



Symptomatology.- Resume of Essential Features. A brief resume of 

 the characteristic symptoms and findings in the different stages is here given. 



First Stage. The bodily structure shows various anomalies and de^ 

 f ects : disproportion of various skeletal units ; teeth late and usually char- 

 acteristically anomalous, so that the lateral incisors are very small, the cen- 

 tral incisors disproportionately large, the canines of the type of incisors 

 with a cutting edge instead of a tearing point ; epiphyses slow in joining 

 shafts of bones; hyperextension of joints; hair growth late and sparse; 

 cramps in muscles; tendency to hemophilia and spasmophilia ; enlarged 



Fig. 2. Sella turcica small and entirely enclosed and "roofed in." It is the 

 ability of this sella to enlarge which determines the later, successful compensation. 



thymus; maxillary torus; tonsils large and adenoids present; cyanosis of 

 extremities ; f atignability ; small sella turcica ; enuresis ; low CO 2 coeffi- 

 cient of the blood. Figs. 1, 2, 3. 



Second Stage. This begins at about the age of puberty ; rapid skeletal 

 growth takes place ; the menses are late and the uterus is small or infantile ; 

 There is great fatiguability with evidence of a low adrenalin supply 

 low blood sugar; low carbon dioxid combining power of the blood; white 

 line of adrenal insufficiency; the pubic hair is of inverted type; there is 

 lack of hair on the face and chin and in the axilla ; the skin is smooth and 

 soft like that of a child ; the genitals are of inverted type or else there may 

 be vagotonia with symptoms of hyperacidity and gastric ulcer; enuresis 

 may be present; undue length of long bones; low blood pressure; little 

 stamina ; mentally, there is lack of initiative and concentration. 



Third Stage. Twentieth to thirtieth year ; beginning gigantism mani- 



