306 CLINICAL CONSIDERATIONS 



tion. It has been suggested that the discoloration is due to 

 sulfur derivatives normally removed from the circulation by 

 the adrenals, or to some deficiency of the skin which causes 

 the deposition of melanin, or to a protective mechanism on the 

 part of the skin. The above cited clinical facts do not sup- 

 port these assumptions. Further experimental work is neces- 

 sary before we can arrive at a satisfactory conclusion as to the 

 mechanism of the pigmentation. The difficulty (if not the 

 impossibility) of producing pigmentation in experimental ani- 

 mals has rendered a solution of this problem difficult. It ap- 

 pears most likely that pigmentation results from a change in 

 the human skin, due to the deficiency of the cortical hormone, 

 and is merely an exaggeration of the normal pigmentary pro- 

 cesses. It may not be caused by deposition of epinephrine, 

 its related compounds, or other normal or abnormal products 

 of the adrenal glands (cf. Chapter V). 



Loss of weight. Loss of weight which is so important a 

 symptom of adrenal insufficiency in experimental animals is 

 also a valuable index in gauging the progress of Addison's 

 disease. The body weight is markedly reduced during exacer- 

 bations of the disease and is increased during remissions. 

 Despite the loss of weight, the skin maintains its elasticity and 

 hence does not give the flabby appearance characteristic of 

 other wasting diseases. 540 



Digestive disturbances. In an analysis of 160 cases of Addi- 

 son's disease, Marafion, Sala, and Arguelles 429 found the fol- 

 lowing digestive disturbances: 



Cases 



Intense hunger 3 



Inappetence (anorexia) 142 



Dyspepsia 61 



Nausea 39 



Gastric ulcer 3 



Diarrhea 45 



Constipation 35 



Pseudo-peritonitis 11 



Hiccough 43 



No digestive symptoms 19 



