addison's disease 305 



medulla was partially destroyed by the insertion of needles 

 containing radium emanations. In rats in which the medulla 

 and most of the cortex was extirpated, the author failed to ob- 

 serve pigmentation of the shaved skin after exposure for several 

 months to the sunlight. These results as well as the absence 

 of pigmentation in adrenalectomized animals maintained for 

 long periods on cortical hormone would indicate that it is not 

 the presence of a precursor of epinephrine which is responsible 

 for the pigmentation. It is possible of course that in the 

 diseased medulla epinephrine itself or its precursor is converted 

 to a product which is deposited in the skin. 



It has recently been suggested that the absence of ascorbic 

 acid in the diseased adrenal is responsible for the pigmentation 

 and a case has been reported in which injection of this vitamin 

 caused a disappearance of the pigmentation. This seems very 

 improbable, however, if one considers the wide distribution of 

 ascorbic acid in the body (cf. Chapter XX). 



From a chemical consideration (cf. Chapter V) and from 

 the arguments cited above, one would incline to the view that 

 disease of the medulla is responsible for the pigmentation. 

 However, in cases of adrenal atrophy in which only the cortex 

 is destroyed while the medulla remains apparently healthy, 

 one still finds marked pigmentation. 668 Unless one assumes 

 that the diseased cortex acts upon a precursor of epinephrine 

 or interferes with the normal function of the medulla, it is 

 difficult to accept the view that in these cases the medulla is 

 responsible for the pigmentation. 



Geenhow 241 reported two cases and Bristow 119 one case of 

 complete destruction of the glands by carcinoma in none of 

 which was there any pigmentation. The only one of 28 cases 

 described by Barker 39 in which pigmentation was absent was 

 one in which some functional medullary tissue was demon- 

 strable. 



From a clinical standpoint it is thus difficult to decide as 

 to the anatomical basis for the appearance of the pigmenta- 



