302 CLINICAL CONSIDERATIONS 



meriting of the skin and mucous membranes : the patients 

 succumb under a gradually increasing cachexia, not rarely 

 with stormy terminal manifestations; autopsy almost al- 

 ways shows disease of both suprarenals, mostly tubercu- 

 lous caseation." 

 Although the typical course of the disease leads to a fatal 

 result in two to four years, chronic types have been reported 119 

 in which patients have lived for ten or twenty years after the 

 onset of the initial symptoms. In the acute forms death may 

 follow in less than a week. Thus in a case due to thrombosis of 

 one adrenal and infarction of the other, death occurred in five 

 days. 119 The average duration of the disease is about two 

 years and varies according to the underlying pathological proc- 

 ess as discussed later. 



SYMPTOMATOLOGY 



Asthenia, pigmentation, loss of weight, digestive disturb- 

 ances (anorexia, nausea, vomiting, constipation, diarrhea), and 

 abdominal or lumbar pain constitute the chief symptoms of 

 complaint of patients suffering from Addison's disease. 



The symptoms of the disease will vary depending upon the 

 stage of its development. In an acute crisis the gastrointes- 

 tinal disturbances— nausea, vomiting, diarrhea, abdominal 

 pains — may be the outstanding symptoms and lead to an er- 

 roneous diagnosis of an acute "surgical" abdomen. Hiccup 

 may precede the onset of a crisis. 



In the chronic stages of the disease, asthenia, weakness, 

 pigmentation, hypotension, and decreased resistance to disease 

 are the predominant symptoms. 



Asthenia. Asthenia (physical and psychic) is the most char- 

 acteristic and constant symptom. There is extreme lassitude 

 and constant fatigue, which steadily progresses in its severity 

 except during periods of remission. The patient ultimately 

 is unable to rise from bed or even to perform the slightest move- 

 ments. 540 



