308 CLINICAL CONSIDERATIONS 



The agonal symptoms may be accompanied by clonic convul- 

 sions, delirium, and stereotyped movements similar to those 

 observed in insulin poisoning. These symptoms, which are 

 also not infrequently observed in experimental animals, are 

 sometimes probably due to hypoglycemia. 17 - 473 



CIRCULATION 



Addison 7 noted the small, weak, easily compressible pulse 

 of his patients. Wilks 681 observed the extreme hypoplasia of 

 the heart with its tortuous coronary arteries. The heart 

 sounds described by Addison as discernible over the apex are 

 probably attributable to the anemia of his patients. The hypo- 

 plasia of the heart and large vessels has been frequently noted, 

 the transverse diameter of the heart being only 8 cms. in a 

 case described by Zondek. 543 Rowntree 538 has reported the 

 occurrence of precordial pains in some of his patients. In a 

 series of 35 cases, this observer noted inversion of the T-wave 

 in 2 cases, auricular fibrillation in 1 case, and heart block in 

 another. The heart was normal in all the other cases. 



Sampayo and his collaborators 543 have recently examined 

 the circulatory system of a large series of patients suffering 

 from Addison's disease. They noted as constant findings a low 

 potential of the electrocardiogram with evidence of conduc- 

 tion defects in the P-Q, Q-R-S, and S-T complexes. The 

 degree of these changes in the electrocardiogram was propor- 

 tional to the intensity of the disease. 



There are, however, no clinical signs of cardiac decompensa- 

 tion. In fact, the above described findings are those one 

 might expect from an asthenic myocardium in fatigue re- 

 sponding to a diminished demand on the part of the organism. 



Hypotension is usually considered as one of the most impor- 

 tant findings in Addison's disease, but its significance has prob- 

 ably been overestimated. The average blood pressure in 

 Rowntree's 538 series was 96/67; with a maximum systolic pres- 

 sure of 115, diastolic, 85; minimum systolic pressure, 60, diasto- 



