PATHOLOGY OF CORTICAL INSUFFICIENCY 177 



It is practically always found in dogs and rats. Its signifi- 

 cance, however, has not been determined. It is questionable if 

 the observed changes are of the nature of a true pancreatitis 

 to which one might attribute some of the symptoms of adrenal 

 insufficiency. Rogoff and Stewart 528 describe the pancreatic 

 changes as consisting of dilatation of the small vessels in the 

 islets with marked congestion of the veins in the trabeculae. 



CIRCULATORY SYSTEM 



The heart shows no abnormality in most cases. In frogs 

 dying of adrenal insufficiency Loewi and Gettwert 401 found the 

 heart markedly dilated. In cats, Moore and Purinton 459 ob- 

 served the heart to be filled with clots formed during life. The 

 increased coagulability of the blood in adrenal insufficiency 

 may account for their occurrence, although in dogs or cats 

 dead of insufficiency one often observes that the blood does 

 not clot when shed. 31 



The blood vessels also manifest no obvious pathological 

 changes. During life they are so markedly collapsed in the 

 agonal stages of insufficiency that it is difficult to draw blood 

 from them. This collapse is probably secondary to a combina- 

 tion of effects due to loss of blood volume, the weakened 

 cardiac action, the hypotension, and possibly the stagnation 

 of blood in the congested visceral organs. 



CENTRAL NERVOUS SYSTEM 



Although earlier observers described vacuolization of nerve 

 cells particularly in the medulla oblongata and cerebral cortex, 

 their animals died several hours after adrenalectomy and hence 

 their observations can not be ascribed to uncomplicated adrenal 

 insufficiency. There has been no recent work on the nervous 

 system in insufficiency, and further studies in this field are in- 

 dicated. It is questionable if the mental symptoms observed 

 in adrenal insufficiency in animals or in man (Chapter XXI) are 

 due to anatomical changes in the cerebrum or whether these 



