addison's disease 311 



normally does. The sugar tolerance curve is also often mark- 

 edly abnormal in Addison's disease. 



METABOLISM 



Although adrenal insufficiency in mammals, as we have seen 

 (Chapter XIII), is attended regularly by a decrease in the 

 basal metabolic rate, this decrease is not always observed in 

 man. Of 13 cases studied by Rowntree, 638 8 showed a normal 

 metabolic rate, one with active pulmonary tuberculosis showed 

 a B. M. R. of +20, and the remaining 4 cases had a B. M. R. 

 of -30, -20, -13, and -10, respectively. Of the 38 cases 

 studied by Rowntree and Snell, 640 only 13 showed a low basal 

 metabolic rate. Maranon, Pena, and Florit 427 observed a 

 normal metabolic rate in two-thirds of their 52 cases. About 

 a quarter of their cases showed a decreased metabolism while 

 the remainder showed an actual elevation. These findings are 

 in essential agreement with those of other investigators. 240 



Addison's disease is often complicated by the co-existence 

 of tuberculous infection elsewhere in the body which may ac- 

 count in part for the normal and elevated rates, for the pyrexia 

 of tuberculosis is occasioned by an increased metabolic rate. 

 Maranon's observation of the depressing effect of cortical ex- 

 tracts on the metabolism of his patients is undoubtedly due to 

 the presence of noxious impurities in the extracts. Potent 

 preparations cause a rise in the metabolism to its normal level 

 in the experimental animal. 



Although the temperature is usually reduced, it may sud- 

 denly rise to hyperpyrexic levels, particularly in the terminal 

 stage of the disease. This hyperpyrexia may possibly be due 

 to a flare-up of the tuberculous infection rather than to any 

 cause related to the adrenal insufficiency. It may, on the 

 other hand, possibly be a reaction analogous to that observed 

 experimentally in an acute partial insufficiency (c/. Chapter 

 XIII). The average temperature in Rowntree and Snell's 540 

 series of patients was 36.1° to 36.7°C. (97° to 98°F.) with pre- 

 mortem rises to 39.4° to 40°C. (103° to 104°F.). 



