American Journal of Clinical Nutrition, Vol 27, 531-543, Copyright © 1974 by The American Society for Clinical Nutrition, Inc.

The clinical pattern of cretinism as seen in highland Ecuador

¹ From the National Polytechnic School, Department of Radioisotopes, and Central University, Faculty of Medicine, Quito, Ecuador

Ninety-four obviously retarded and defective persons from a region of severe endemic goiter in Andean Ecuador have been selected for intensive study. In terms of mental capacity, hearing, language, gait, and occupation, only differences in degree existed between extreme deficiency and normal subjects in the two communities from where these subjects were drawn. For purposes of definition, only those persons were considered cretins whose mental capacity corresponded to idiocy and imbecility, i.e., persons with IQ's below 50.

Subjects diagnosed as endemic cretins presented defects in language which ranged from normal to complete mutism, in hearing from normal to total deafness, and in gait from normal to total inability to walk. The motor disabilities were due to spastic diplegia of variable severity and to coxa valga. In addition to endemic cretins, the study group included subjects whose IQ's scored between 50 to 70%. There was no sharp distinction between these subjects and those who were typically cretin.

Among the cretins, 90% presented no clinical evidence of myxedema. Thus, the predominant form of the disorder in the Andean region corresponds to the so-called "nervous endemic cretinism," rather than to the "myxedematous cretinism" of central Africa. Those cretins in whom both neurological impairment and hypothyroid manifestations were evident, would be examples of "mixed endemic creatinism."