addison's disease 309 



lie, 40. Values as low as 30 or 40 mms. for the systolic 

 pressure have been reported, but such values are inconceiv- 

 able in the light of our generally accepted concepts of circula- 

 tory hemodynamics. 243 



Janneway first called attention to the fact that a low blood 

 pressure is not as constant a finding in this disease as is gener- 

 ally believed. In a quarter of Snell and Rowntree's 540 cases 

 the systolic pressure was 105 mms. or more and in one case the 

 blood pressure was 145/100 one week before death. The com- 

 monly accepted view concerning the indispensability of hypo- 

 tension in arriving at a clinical diagnosis of Addison's disease 

 is thus erroneous. To attribute the observed hypotension to 

 disease of the medulla and the absence of epinephrine secre- 

 tion is also untenable, for cases of adrenal atrophy in which 

 the medulla is spared are also accompanied by the usual degree 

 of hypotension. 



It may be emphasized that the average blood pressure of 

 normal, healthy individuals in the basal resting condition is 

 only 105/67, which is much lower than the values obtained 

 under usual clinical conditions. 243 The marked asthenia of the 

 patient with Addison's disease will render truly basal values 

 readily obtainable. The reduced metabolism observed in 

 some patients and a vascular hypoactivity comparable to that 

 observed in the rest of the tissues will also tend towards a low 

 blood pressure. 243 All of these factors suffice to explain the 

 observed hypotension without necessitating the assumption 

 that some normal pressor agent is absent from the blood in 

 Addison's disease. 



Patients with Addison's disease often suffer vertigo and 

 faintness in changing from the recumbent to the upright posi- 

 tion. There is, however, a rise in blood pressure during this 

 change in posture which differentiates this condition from pos- 

 tural hypotension. 540 



The average pulse rate in Rowntree and Snell's series of pa- 

 tients was 94. This elevation of the pulse rate in the presence 



