312 CLINICAL CONSIDERATIONS 



RESPIRATION 



The respiration in Addison's disease is usually normal except 

 for dyspnoea on exertion, sighing, and yawning. In crises, the 

 respiration may become irregular with the Biot type of respira- 

 tion commonly seen in cerebral involvements. 540 



REPRODUCTION 



In the late stages of Addison's disease there is loss of the 

 reproductive activities and loss of libido. The failure of the 

 reproductive system in women manifests itself first in irregular 

 menstruation, oligomenorrhea, and amenorrhea. Conception 

 is rare but cases have been reported in which normal pregnancy 

 has proceeded to term. 119 During pregnancy the symptoms 

 of the disease are ameliorated, probably for the same reasons 

 suggested (Chapter VIII) for the prolonged survival of adre- 

 nalectomized pregnant animals. In men there may be impo- 

 tence. 540 



LIFE EXPECTANCY 



Although there is no fixed order in the appearance of the 

 symptoms, asthenia usually precedes the melanoderma. At 

 times, however, the pigmentation may precede the appearance 

 of the other symptoms. Though there is often a gradual in- 

 crease in the severity of the symptoms, usually the disease is 

 marked by paroxysmal remissions with intermissions during 

 which the patient may be in fair health. 



The "paroxysmal mode of progress" of Addison's disease 

 has been aptly described by Greenhow 242 as follows : 



"The asthenia, the constitutional symptoms generally, 

 and the change of colour in the skin are all, it is true, 

 progressive, but not steadily so. The course of the dis- 

 ease, on the whole, is slow and chronic; but it is subject 

 to alternate exacerbations and remissions, usually in some 

 degree dependent upon favourable and unfavourable cir- 

 cumstances but sometimes also apparently quite independ- 



