320 CLINICAL CONSIDERATIONS 



have been rarely noted at autopsy. The occurrence of spiro- 

 chaetes in such lesions in a case dying of Addison's disease has 

 been reported. 417 



Other findings. Rare changes in Addison's disease are 

 echinococcus cyst, mycosis fungoides, abscess formation follow- 

 ing pneumonia, trauma, and vascular lesions. Among the last 

 named, venous thrombosis, 59 arterial embolism, and hemor- 

 rhage into the substance of the adrenal have been reported as 

 causative agents of Addison's disease. 260 ' 417 



OTHER AUTOPSY FINDINGS IN ADDISON'S DISEASE 



Due to the concomitant presence of tuberculosis, the ravages 

 of this disease will usually be present at autopsy in patients 

 dying of Addison's disease. 



Among Barker's 39 75 cases of adrenal tuberculosis, there was 

 active pulmonary tuberculosis in 10, genito-urinary tubercu- 

 losis in 4, and both genito-urinary and pulmonary tuberculosis 

 in 2 cases. Of the remaining 8 cases, there was active tuber- 

 culosis of the spine, liver, spleen, or abdominal lymph nodes in 

 5. In only 3 cases could no active tuberculous lesions of other 

 organs be demonstrated. Gsell and Uehlinger, 255 on the other 

 hand, report the active tuberculous process to be limited to the 

 adrenals in one-third of their cases. 



The body is usually wasted, although extreme emaciation is 

 not present. The heart may show atrophic changes. Its walls 

 are thin causing the coronary vessels to run a tortuous course. 

 The cardiac muscle itself may be distinctly brown. The blood 

 vessels show no distinctive changes except for the hypoplasia 

 of the aorta and large vessels. 543 



The stomach shows atrophy of the mucosa. The intestines 

 may contain fluid faeces and the lymphoid follicles throughout 

 the alimentary tract are hypertrophied. 



As might be anticipated from the renal impairment observed 

 in adrenal insufficiency both experimentally and in Addison's 

 disease, renal lesions are often demonstrable at autopsy. Bar- 



