Treatment of Simmonds' Disease

It has now been almost 30 years since Simmonds (1) described the syndrome associated with extensive pituitary destruction. Since then, there have been many reports of the various clinical and pathological manifestations of this disease (2). In a number of the reports, however, the clinical diagnoses are not well established. The diagnosis is sometimes difficult to make and has, not infrequently, been missed. Nevertheless, with the methods now available for study, the diagnostic accuracy has increased. Although in this report we are chiefly concerned with the treatment of Simmonds' disease, we will also emphasize certain diagnostic features, since the proper understanding of these increases the efficiency of treatment. The disease is always associated with marked destruction of the anterior pituitary gland. The cause of the destruction is varied, although most commonly it is postpartum necrosis (3) or a tumor. As a result of this destruction there is a marked decrease in the function of the thyroid, adrenals and gonads.