310 CLINICAL CONSIDERATIONS 



of a reduced metabolic activity is similar to that observed in 

 the early stages of experimental adrenal insufficiency. Its 

 significance is still unknown. 



Blood picture. Although considered by Addison as a form 

 of "idiopathic anemia," the blood picture in Addison's disease 

 is not usually strikingly abnormal. There is only a slight re- 

 duction of hemoglobin to about 85 per cent of normal. Al- 

 though the leucocyte count is within normal range, there is at 

 times a lymphocytosis, first observed by Neusser. 468 This 

 lymphocytosis is probably a reflection of the generalized hyper- 

 trophy of the lymphoid tissue which is often noticeable clini- 

 cally by the enlargement of the tonsils, papillae of the tongue, 

 and a persistent thymus. There is often also an increase in 

 the number of the large mononuclear cells while the neutro- 

 philic cells are relatively and absolutely reduced in number. 260 



Blood chemistry. The marked changes observed in the com- 

 position of the blood of adrenalectomized animals in adrenal 

 insufficiency have been described in Chapter XI. In Addison's 

 disease one fails to note these striking abnormalities of the 

 blood chemistry. During a crisis, however, changes very 

 similar to those already described as occurring in experimental 

 animals are encountered. Thus the sodium concentration may 

 be reduced to about 120 milli-equivalents per liter in contrast to 

 its normal value of 140. 399 The chloride and bicarbonate ion 

 concentrations are correspondingly decreased while the potas- 

 sium ion concentration is increased. The non-protein nitrogen 

 and urea nitrogen may assume values twice as great as the 

 normal. The total base of the blood is diminished. Due to 

 the hemoconcentration attendant upon the loss of body fluid, 

 the serum protein concentration becomes elevated. The blood 

 sugar is often reduced to convulsive levels but, in many cases, 

 practically normal values persist despite marked alterations in 

 the concentration of other blood constituents. 640 Injection of 

 epinephrine does not cause the rise in the blood sugar which it 



