The Pituitary Type of Myxedema

Last year Means, Hertz and Lerman1described their sequence of experiences leading to the recognition of the pituitary type of myxedema. First it was noted that patients with Addison's disease have acute adrenocortical failure when thyroid is administered to them; second, that some patients with apparent myxedema do not respond well to thyroid. One such patient actually went into coma and died. At autopsy2the endocrine organs presented the characteristic changes of Simmonds' disease, namely, atrophy of the pituitary, thyroid, parathyroids, adrenals and ovaries. This knowledge permitted them to establish the proper diagnosis and institute proper treatment when the next patient with apparent myxedema went into coma on administration of active thyroid material. Our purpose in the present report is to describe in more detail the metabolic studies made on this patient and to describe the pathologic manifestations in another case recognized before death.