Simmonds' Disease. A Clinical Study with Review of the Literature; Differentiation from Anorexia Nervosa by Statistical Analysis of 595 Cases, 101 of Which Were Proved Pathologically1

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Abstract
595 cases of Simmonds'' disease have been subdivided into 7 groups, and are presented in tabular form. In 101 cases the diagnosis of Simmonds'' disease was established both clinically and pathologically. In 158 cases the clinical picture seemed typical, but the patients were either still living or autopsy had not been performed. Many of these were cases of anorexia nervosa. The cardinal features of clinical Simmonds'' disease were: a) marked loss of wt., often progressing to cachectic emaciation; b) loss of sexual function[long dash]amenorrhea in the [female], loss of libido and potency in the [male], and usually sterility in both sexes; c) a low basal metabolic rate. Asthenia was also a common symptom but did not seem to have as much diagnostic significance. It should be relatively simple to eliminate advanced tuberculosis, malignant disease, and thyrotoxicosis as causes of cachexia as none of these conditions is associated with a low basal metabolic rate. Difficulty in differentiating Addison''s disease from Simmonds'' disease is not great. The most difficult problem is the differentiation between true Simmonds'' disease and anorexia nervosa. The occurrence of severe wt. loss and a low basal metabolic rate in a young unmarried o who has never been pregnant favors the diagnosis of anorexia nervosa. Marked improvement or return to normal health, as a result of psychotherapy or any other form of treatment available at present (endocrine therapy included), further suggests this diagnosis. A claim of cure in any case of true Simmonds'' disease is open to doubt unless a pituitary tumor has been removed successfully. The occurrence of severe wt. loss, amenorrhea and a low basal metabolic rate in a [female] over 30 yrs. of age, whose symptoms date from a post-partum hemorrhage and collapse, or whose sella turcica is deformed or contains calcification, and who in the course of the disease loses axillary and pubic hair, warrants a clinical diagnosis of Simmonds'' disease. Psychopathic disturbances favor the diagnosis of anorexia nervosa, but by no means exclude the possibility of the presence of true Simmonds'' disease.