FUNCTION OF THE ADRENAL CORTEX IN MYXEDEMA, WITH SOME OBSERVATIONS ON PITUITARY FUNCTION*

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Abstract
AS OUR knowledge of thyroid and pituitary function developed, it became clear that there are two types of myxedema—one due to primary thyroid failure and the other due to pituitary failure with secondary thyroid atrophy. A differential diagnosis between these two conditions is always difficult and can be made only after careful evaluation of clinical and laboratory data. In the diagnosis of pituitary myxedema considerable weight is given to the concomitant absence or diminution of the various tropic hormones of the pituitary, or of adrenocortical failure. However, interpretation of data is made difficult by the knowledge that primary myxedema may of itself depress pituitary and adrenal function. Consequently, this study was initiated to determine to what degree the pituitary and adrenals are affected by primary myxedema. In the literature there is a limited amount of data on this subject. Friedgood (1) demonstrated low excretion of 17-ketosteroids in the urine of 10 patients with spontaneous and post-thyroidectomy myxedema. Therapy did not raise the values. Talbot et al. (2) demonstrated low normal 17-ketosteroid values in 9 hypothyroid children, and subnormal values in 3. Engstrom and Mason (3) reported diminished excretion in 13 cases. In the 10 cases of spontaneous myxedema there was no change following therapy up to one year, but in the 3 post-thyroidectomy cases there was an increase. One patient with myxedema had an elevated excretion. Escamilla (4), on the other hand, reported a somewhat higher than normal level in 4 women with hypothyroidism and a low level in 1 myxedematous male.