PATHOLOGY OF CORTICAL INSUFFICIENCY 173 



hemoconcentration, as we shall see in Chapter XI, is probably 

 due to loss of fluid through the kidneys due to tubular injury 

 which prevents reabsorption of water and threshold substances. 

 The tissues also appear to be dehydrated showing that there 

 has also been a loss of fluid from the tissue spaces. Obviously 

 the loss of fluid from the circulation can not have been due to 

 damage of the capillary endothelia with a consequent inability 

 to retain fluid, as has been claimed; for if such were the case 

 one would observe an edematous swelling rather than dehy- 

 dration of the tissues in adrenal insufficiency. 



In animals which have been maintained for sometime in a 

 state of cortical insufficiency, one notes at autopsy an almost 

 complete disappearance of the body fat. The anorexia seen 

 in insufficiency leads to starvation with the depletion of the 

 reserve stores of fat and carbohydrate of the body. 



GASTRO-LNTESTINAL TRACT 



The outstanding pathological finding at autopsy of animals 

 dying of acute adrenal insufficiency is a marked hyperaemia 

 of the visceral organs — stomach, intestines, liver, spleen, kid- 

 ney, pancreas, thymus, and hypophysis. Frequently, hemor- 

 rhages into the gastro-intestinal canal are prominent and 

 ulceration may be visible. There may be submucosal ecchymo- 

 ses in the intestinal tract. The gum margins are often con- 

 gested and bluish and ulcers may be found under the tongue. 31 



Lesions of the gastric mucosa are found in a large percentage 

 of rats, mice, cats, and dogs dying of adrenal insufficiency. 

 There may be an injection of the mucosa, widespread super- 

 ficial erosions, or true punched-out ulcers. 197 The ulcers de- 

 velop at the site of local hemorrhages in the gastric mucosa and 

 penetrate to the muscular coat of the stomach with complete 

 destruction of the mucosa. The ulcers as observed in the 

 dog 423 are round or oval, 2 to 20 mms. in diameter, and are 

 usually multiple although at times a single ulcer may be en- 

 countered. They are cone-shaped with the base at the sur- 



