Pineal Stigmata

(occur only in children)

Precocious sexual and mental development.

It will be noted that he associates manic symptoms, increased emotional irritability, ideas of reference and persecution with thyroid hyperactivity and speaks of a sluggish mentality in pituitary deficiency and gonadal stigmata. Blumgarten's summary of these conditions is very interesting: "The study of the various stigmata shows that many of these are present regularly in certain types of individuals. Consequently we may group individuals from an endocrine viewpoint into various types according to the prominent endocrine stigmata which they show. For example, the nervous, thin individual with tachycardia, rather prominent eyeballs, fine, delicate hair, suffering occasionally from gastric symptoms, suggests the thyroid type, as does also the clean-cut, alert individual, and the young woman suffering with amenorrhea and a tendency to obesity and lethargic mentality. On the other hand, the aggressive, energetic individual, with the history of an ancestry subject to vascular disease, with high blood pressure, with abundant, unusual distribution of hair and a tendency to pigmentation, suggests the adrenal type. And so does the tired, asthenic individual with low blood pressure and Sergent's white line, who may have had influenza or diphtheria and even may be suffering from tuberculosis. On the other hand, however, the heavily built individual with broad, large frame, wide intercostal angle, broad nose, prominent supra-orbital ridges, prominent lips, large, square fingers, suggests the pituitary type. These individuals are very fond of meats, are heavy eaters, and are constantly subject to diseases of a gouty nature, may have a history of syphilis, are often musical and, as a rule, are usually successful in their particular community."

According to Kaplan[108] "such states as lack of courage, melancholy, suicidal tendencies, dementia praecox, precocious adolescence, and immature senility, sadism and masochism; all of these are possible manifestations in a gonadotrop individual." Garretson[109] is of the opinion that the "large group of patients generally misunderstood and frequently classed in civil life as neurasthenics, psychasthenics, hysterics, cyclothymics, and hypochondriacs, is now capable of an intelligent analysis and rational therapy, if one will concede that these are the victims of an endocrinic asthenia."

As an evidence of the influence of the endocrine glands on psychical functions, Falta[110] refers to "the alteration in character that is almost always associated with the development of Basedow's disease; to the psychical irritability, the inclination to irascibility, the manic-euphoristic attitude of patients with Basedow's disease; to the apathy and lack of interest of the myxedematous; to the characteristic quiet mental attitude in hypophysial dystrophy, and the feeling of mental want of strength in those suffering with Addison's disease; to the depressive attitude of the tetany patient, and finally to the profound influence that the ripening of the sexual glands at the time of puberty or the loss of function of the sexual glands in castrates exercises on the psyche." Going into this subject more in detail Falta gives the following mental symptoms as associated with Basedow's disease: abnormal irritability, "immotivated" gaiety, hasty speech, rapid flow of thoughts, a suggestion of flight of ideas, changeable moods and terrifying dreams. He also finds an alteration in the personality as shown by suspiciousness, capriciousness, irritability and either euphoric or depressed tendencies. Möbius compares this with a condition of mild intoxication associated with maniacal periods alternating with depression. Occasional attacks of delirium with confusion and hallucinations terminating in coma have been described. Sattler, who has analyzed 150 of these cases as reported in current literature, classifies over seventy as cases of manic-depressive insanity. Boinet, Parhan and others have shown that depression with suicidal inclinations may follow the ingestion of large amounts of thyroidin. Conditions of excitement have also been reported in thyroidism, and, according to Falta, are not uncommon. Brunet has expressed the opinion that in such cases Basedow's disease acts only as a precipitating factor in an individual predisposed to a psychosis.

The English Myxedema Commission found the apathy characteristic of that disease present in all but three of 109 cases. This condition develops early and may manifest itself in the form of a mild mental dulness. Intellectual activities are often markedly diminished and there is a slow, monotonous form of speech. Deterioration may be well developed and memory seriously impaired. The commission in its investigations found illusions in eighteen cases, hallucinations in sixteen and psychoses in sixteen. These took the form usually of a depression with occasional excitements. The symptoms, in some cases at least, disappeared after thyroid treatment was instituted.

The psychic changes in cretinism have been made the subject of considerable study. The usual mental state is, of course, one of feeblemindedness. Perception has been shown to be disturbed, memory is impaired and there is a marked emotional deterioration and instability.

In the parathyroid form of tetany von Frankl-Hochwart found depressions and confused states with hallucinations. Depressions were reported by him in fourteen of thirty-seven cases examined. Excitements were also noted in some instances. Falta refers to "a characteristic apathy, a want of initiative, and a slowing of speech" in acromegaly. In rare cases he has also noted mental exaltation. Oppenheim (1914) has called attention to cases of acromegaly presenting the picture of general paresis but due to an alteration of glandular functions and not syphilitic in origin.