addison's disease 307 



Intense hunger which is an infrequent complaint was only ob- 

 served during the beginning of the illness. Anorexia is the 

 most common digestive complaint. The mere sight of food 

 may arouse nausea. Vomiting is a troublesome symptom par- 

 ticularly in the late stages of the disease. 



The severe diarrhea as seen in experimental adrenal insuf- 

 ficiency also occurs in man and may simulate, in its appearance, 

 cholera nostras. The pseudo-peritonitis referred to above, is 

 marked by spasm of the abdominal muscles, by a small pulse, 

 and in general may give the appearance of an acute affection 

 of the abdomen. 



An aversion to fatty foods has been noted by Rogoff 522 as 

 an important early symptom. 



One of the common findings in experimental adrenal insuf- 

 ficiency, as we have seen (Chapter X), is inflammation and 

 ulceration of the gastro-intestinal tract and digestive disturb- 

 ances identical to those observed in Addison's disease. The 

 disturbances observed in man may possibly be due to an in- 

 flammation of the gastro-intestinal tract similar to that ob- 

 served in experimental adrenal insufficiency. In the late 

 stages of the disease there may be a diminution or even absence 

 of the gastric hydrochloric acid and of the ferments. 119 



Nervous manifestations. Certain nervous and mental mani- 

 festations often occur in Addison's disease. The patient may 

 be apathetic, listless, depressed, or irritable; mental activity 

 is often impaired; neuralgic pains occur in the lumbar region, 

 in the epigastrium, and in the extremities; headaches, tinnitus 

 vertigo, rheumatoid pains, and insomnia are sometimes present. 



Pain in the back may be an early symptom and was present 

 in every case in Snell and Rowntree's series. Pain on pressure 

 in the costolumbar angle has been considered a noteworthy 

 symptom. 522 



In the late stages of the disease, nervous symptoms may be- 

 come prominent. Delirium, acute mental confusion, convul- 

 sions, numbness, and coma are common as terminal symptoms. 



