Brun J M
Ann Endocrinol (Paris). 1978;39(6):463-81.
The observation on a young girl of a chronic mucocutaneous candidiasis associated with a pernicious anemia and a primary defect of parathyroid, adrenal and gonadal functions has brought us to a general review on non tumoral, multiple endocrinopathies in children. The analysis of the 47 observations of literature including the symptomatic triad, moniliasis, hypoparathyroidism and adrenal insufficiency, correlated with 107 other cases including only an incomplete triad but other well systematized associations, brings us to enlarge the fame of Whitaker's syndrom, to the more generalized one of auto immune juvenile poly-endocrinopathies. It seems to us that this new entity can be individualized: --by clinical features, linked to the age of occurence, to the predilection for the female sex, the specific chronology of the symptoms (moniliasis, hypoparathyroidism, primary hypothyroidism, adrenal and gonadal insufficiencies, Hashimoto thyroiditis, chronic diarrhoea, alopecia, pernicious anemia, "idiopathic" liver disease). --by genetic findings : compatible with an autosomic recessive transmission. --by the antaomo pathological aspect of the destroyed endocrine glandes on which the lymphocyte infiltration rises. --and by the etiopathogenic mechanism which is certainly linked to a defect of cell mediated immunity. Moreover, these different features seem to differentiate this juvenile syndrom from the polyendocrinopathies of the adult.
对一名患有慢性黏膜皮肤念珠菌病、伴有恶性贫血以及甲状旁腺、肾上腺和性腺功能原发性缺陷的年轻女孩的观察,促使我们对儿童非肿瘤性多发性内分泌病进行全面回顾。对47例文献观察(包括念珠菌病、甲状旁腺功能减退和肾上腺功能不全这一症状三联征)以及107例其他病例(仅包括不完全三联征但有其他系统关联)的分析,使我们将惠特克综合征的范围扩大到更普遍的自身免疫性青少年多发性内分泌病。在我们看来,这个新实体可以通过以下方式个体化:——通过临床特征,与发病年龄、女性偏好、症状的特定时间顺序(念珠菌病、甲状旁腺功能减退、原发性甲状腺功能减退、肾上腺和性腺功能不全、桥本甲状腺炎、慢性腹泻、脱发、恶性贫血、“特发性”肝病)相关联。——通过遗传学发现:与常染色体隐性遗传传递相符。——通过被破坏的内分泌腺的抗amo病理方面,其上淋巴细胞浸润增加。——以及通过病因发病机制,其肯定与细胞介导免疫缺陷有关。此外,这些不同特征似乎将这种青少年综合征与成人的多发性内分泌病区分开来。