408 THE DUCTLESS GLANDS 



diseases affecting the glands of internal secretion it is very 

 common (perhaps even the rule) that more than one of these 

 glands are from time to time or simultaneously involved. The 

 nature of the clinical picture produced depends upon the 

 preponderance of symptoms arising from disorder of one or 

 more of the glands in question whose dysfunction results in 

 recognizable changes. 



Lereboullet classifies pluriglandular disorders as follows : 

 (1) A primary change in one gland with secondary disorders 

 in one or more, e.g. Graves's disease, with ovarian insufficiency 

 and amenorrhoea ; (2) Association of two uniglandular syn- 

 dromes, e.g. myxoedema and acromegaly ; (3) Association of 

 several uniglandular syndromes without predominance of any 

 one. The last condition may be due to syphilis or tubercle 

 and affects commonly thyroid, testis, and adrenal. 



Timme has recently described a condition depending upon 

 disease of thymus, adrenal, and pituitary in combination. He 

 says that this condition is frequently met with and that its 

 various stages are easy of recognition. The chief symptoms 

 are extreme liability to fatigue, a low blood-pressure, head- 

 ache, and inordinate growth of the whole body. A restoration 

 to a normal condition, or to something which approaches this, 

 may be brought about spontaneously by compensatory over- 

 growth and over activity of the pituitary. Feeding with 

 pituitary extracts is the treatment which is found to be most 

 beneficial. 



Pubertas prcecox apparently may arise from affection of the 

 whole ductless gland system, but primarily from the repro- 

 ductive organs, pineal and adrenal cortex. The majority of 

 cases are probably due to some affection of the gonads ; next 

 in frequency are cases apparently due to tumours of the pineal 

 and finally we have those due to growths in the adrenal cortex. 

 It is stated that pineal types occur mostly in the male, the 

 adrenal and gonadal in the female. 



Dercum's Disease, or Adiposis dolorosa, has been included by 

 some writers in this group. It is characterized by irregular, 

 sometimes symmetrical, deposits of fatty masses in various 

 portions of the body, preceded by and attended with pain. It 

 occurs mostly in middle-aged women. There may be a history 

 of alcohol, syphilis, rheumatism, or bodily injury. The fatty 

 masses are of variable size and distributed on the trunk and 



