Chapter X 



ANATOMICAL PATHOLOGY OF ADRENAL CORTICAL 

 INSUFFICIENCY 



Considering the marked and diverse symptoms manifested 

 during life in adrenal cortical insufficiency, one is surprised at 

 autopsy to find relatively little in the nature of gross pathologi- 

 cal changes. A radical dysfunction of an organ may appar- 

 ently be undetected anatomically, particularly when the dis- 

 ability is acute in its onset. In acute adrenal insufficiency, too 

 short a time elapses for the development of gross changes 

 which are evident by the methods of anatomical pathology. 



Pigmentation of the skin which is a striking (although not 

 an essential) symptom of adrenal insufficiency in man, has not 

 been reproduced with certainty in the experimental animals. 

 Some of the earlier investigators (Brown-Sequard, 97 Noth- 

 nagel, 474 Tizzoni, 628 and others) described the deposition of 

 pigment in the skin or blood of animals the adrenals of which 

 had been injured, but subsequent workers have failed to sub- 

 stantiate these claims. Harrop and Weinstein 267 have recently 

 reported some slight pigmentation in an adrenalectomized 

 monkey maintained for some weeks with the cortical hormone. 

 To attain conditions comparable to those obtaining in Ad- 

 dison's disease it is necessary to maintain animals in a state 

 of chronic insufficiency for a long period of time and subject 

 their shaved skin to the sunlight. Thus far such attempts 

 have been futile (c/. Chapter XXI). It is possible that man 

 (and possibly the ape) is unique in that some property of his 

 epidermis permits the deposition of pigment. 



The blood in animals dead of adrenal insufficiency is often 

 thick and dark due to loss of fluid from the blood stream and 

 incomplete oxygenation during the last moments of life. The 



172 



