MtJLTIGLANDULAK SYNDROMES 



913 



pineal involution plays an important role in the symptomatology of pro- 

 gressive muscular dystrophy. He confirms McCrudden and Sargent's 

 findings of hypoglycemia. In 1917 Janney/ Goodhart and Jacobson ex- 

 amined several cases of dystrophy and fQund, likewise, hypoglycemia and 

 delayed glucose utilization. They also placed great stress upon the 

 abnormal appearance of creatin in the urine with normal creatin in the 

 blood. The creatin in the urine, they believe, is always abnormal, and 

 in all probability is allied to the same causal factor that produces urinary 



creatin in myxedema, cretinism, 

 dyspituitarism and Addison's dis- 

 ease all endocrinopathies. 



From several viewpoints, then, 

 the dystrophies are rapidly coming 

 to be regarded as endocrinopathies. 

 Onset, Symptomatology and 

 General Course of the Disease. 

 Under the discussion of "Types of 

 the Disease," practically all the 

 necessary facts of onset and prog- 

 ress are included, hence only a 

 general statement need be given 

 here. The onset may be at any of 

 the earlier periods of life in the 

 far greater number of cases, al- 

 though occasionally one is reported 

 as occurring as late as the meno- 

 pause. The mode of onset is usu- 

 ally insidious a slight difficulty 

 in arising from a sitting position 

 some extra exertion necessary to 

 mount the stairs an increasing 

 disability to raise the arms above 

 the head, are characteristic fore- 

 runners. From this initial dis- 

 turbance, the progress varies. It 

 may spread rapidly to various 



symmetrically disposed rmiscle groups, such as the shoulder girdle group, 

 or the pelvic girdle group, with more or less rapid atrophy of the muscles 

 involved. With the atrophy, contractures in various important tendons 

 take place so that full extension becomes impossible. Thus, the hand and 

 arm cannot be at the same time fully extended, the heel cannot be placed 

 on the floor with the remainder of the foot, unless the knees are flexed. 

 While atrophy of the affected muscles is the rule, other groups apparently 

 hypertrophy. Especially is this true of the calves, which at times seem 



Fig. 12. Brothers both affected by pro- 

 gressive muscular dystrophy. Note hyper- 

 trophic calves and thighs, and atrophic 

 shoulder girdle musculature. Older brother 

 is more advanced in the disease has more 

 atrophy and greater lordosis. Note pos- 

 tures. 



