182 CORTEX 



The accumulation of the waste products of metabolism must, 

 however, exert deleterious effects which add to the other defi- 

 ciences of the organism. 



The increased non-protein-nitrogen observed in adrenal cor- 

 tical insufficiency consists for the most part of urea, the chief 

 end-product of protein catabolism. Other non-protein-nitro- 

 gen constituents such as creatinine and uric acid are also in- 

 creased, the former attaining values several times those ob- 

 served in normal animals. 



WATER 



The water content of the blood and tissues is characteristi- 

 cally altered in adrenal insufficiency. During the early stages 

 of insufficiency a diuresis may occur. This loss of water from 

 the body together with that normally lost through the lungs 

 and skin is not replaced by the ingestion of additional quanti- 

 ties of water. In fact, the animal in adrenal insufficiency 

 manifests no thirst despite the abnormal loss of fluid from its 

 body. Similarly, patients suffering from Addison's disease 

 will not manifest a degree of thirst consonant with the state 

 of dehydration of their tissues. 



The existence of an actual negative water balance in adrenal 

 insufficiency has been experimentally demonstrated 265 • 398 in 

 dogs by the excess volume of the water present in the excreta 

 over the total water intake. The actual loss of water from 

 the body is greater than is indicated in these studies which do 

 not take into account the appreciable loss of water through 

 the lungs. There can be no doubt, therefore, that adrenal 

 insufficiency is accompanied by a loss of water from the body 

 and that there is no attempt to replace this loss by an increased 

 ingestion of fluids. 



Gradinescu 236 in 1913 showed that the concentration of the 

 blood in adrenalectomized animals was accompanied by no 

 change in the electrical conductivity, the freezing point, the 

 viscosity, or the refractive index. He, therefore, concluded 



