900 



WALTER TTMME 



feeding often modifies these characteristics. The symptoms of the un- 

 compensated cases usually merge into those of a frank dyspituitary syn- 

 drome. Blood sugar disturbances, intense fatiguability, periodic head- 

 aches, temperamental unfitness, and drowsi- 

 ness are among the prominent symptoms. 



Etiology. In practically all of our 



^% cases there have heen family histories of im- 



MPy portance as regards endocrinopathies. Fre- 



quently parents or grandparents have shown 



M 





such disturbances as diabetes, goiter, or 



acromegaly. A very common complaint is 

 gigantism. Collateral branches, too, show 

 similar disturbances. Thus, W. W. (Fig. 

 9), the fully compensated case, has four 

 cousins all afflicted with Graves' disease. 

 There appeared in our cases no particular 

 antecedent disabling disease or injury. One 

 patient, now in the second stage, had two 

 brothers, both dying suddenly after exertion 

 without known cause, in youth possibly a 

 so-called thymic death. Periodic headaches 

 are also distinguishing marks. Menstrual 

 disturbances of all kinds are met with here, 

 chiefly the latet-appearing type with lack of 

 periodicity, almost invariably delayed. 



Discussion of Pathogenesis. During 

 the first stage we see a clinical picture which 

 is dominated by the characteristics of the 

 status hypoplasticus of Bartels. The anom- 

 alies have been variously credited to hypo- 

 function of the individual endocrin glands, 

 excepting the thymus, which is supposedly 

 hyperactive. Thus, Tandler and Grosz, and 

 Tandler have described many of the fea- 

 tures of such a condition due to deficiency 

 of the gonads. And yet, in direct contradic- 

 tion to their view that gonadal deficiency 

 produces growth in height with late join- 

 ing of the epiphyses, cases have been 



seen in which, for example, at the age of eighteen with no men- 

 strual flow yet established, the sexual apparatus quite infantile, the 

 skiagram of the long bones showed the epiphyses almost united, the height 

 of the patients being under five feet (personal observation). Wiesel, 

 Schur, and Schmorls and Ingiers have given both clinical descriptions and 



Fig. 9. Height feet, 2% 

 inches. Fully compensated case. 

 Great length of leg compared 

 with length of thorax. Feminine 

 pubic hair; feminine waist: 

 hands of giant type; no hair on 

 face. Able, after many years, to 

 resume efficient work. 4th stage 

 of syndrome. 



