THE IMPORTANCE OF ENDOCRINOLOGY 939 



Physical and mental states similar to those characteristic of eunuchs 

 are occasionally met with in males in whom there has been a hypoplasia 

 of the gonads, or an injury to these structures from disease as in the testic- 

 ular atrophy following the orchitis of mumps. Persons presenting such 

 abnormal states are known as eunuchoids. These males tend to become 

 obese, and in their mental and physical status they suggest the feminine 

 type. 



The changes that take place in women at the menopause are well 

 known to every practitioner of medicine. The amenorrhea, the tendency 

 to obesity and the gradually developing genital atrophy are the outstand- 

 ing features. During the adjustment of the organism to the "change of 

 life" certain well known physical and mental disturbances are common. 

 I refer to the hot flushes, the neurasthenic symptoms and the slight mental 

 anomalies with which we are all familiar. 



The efforts that have been made to counteract the effects of hypogeni- 

 talism by substitution therapy, both medical and surgical, are interesting 

 and may gradually lead to the introduction of therapeutic methods of 

 increasing practical value. 



Hypergenitalism (Pseudohermaphroditism; Premature Puberty; Hir- 

 sutism). In contrast with the effects upon the body of an insufficient 

 supply of the internal secretion of the gonads (hypogenitalism), are 

 the phenomena that have been supposed to result from an excessive sup- 

 ply of these substances (hypergenitalism). On this point, however, it 

 is desirable to speak with great reserve, for though the conditions known 

 as pseudohermaphroditism, premature puberty, and hirsutism suggest a 

 hypergenital state, the evidence in favor of it is far less conclusive than 

 we could wish. The conditions that have been found most often to be as- 

 sociated with these remarkable states include: (1) tumors of the supra- 

 renal cortex; (2) tumors, especially teratomata, of the ovaries; and (3) 

 tumors, especially teratomata, of the pineal gland. The future will doubt- 

 less determine whether or not the so-called hypergenital states resulting are, 

 in reality, due to an excessive supply of the internal secretions ordinarily 

 manufactured by the gonads, or to substances that closely resemble them. 



3. The Multiglandular Endocrin Syndromes 



Knowledge of the clinical pictures mentioned above as being dependent 

 upon disorders of the glands of internal secretion have led clinicians to 

 make careful studies of certain more complex clinical syndromes that 

 would seem to point to disorders, existing simultaneously, of two, three 

 or more of the endocrin glands. These clinical pictures have been desig- 

 nated "multiglandular syndromes" or "pluriglandular disorders." 



That such syndromes exist there can no longer be any doubt, but 

 the very complexity of their origin makes an analysis of their pathogenesis 



