addison's disease 323 



as in the cases quoted by Coneybeare and Millis, 122 lead to an 

 erroneous diagnosis of Addison's disease. Cases of pernicious 

 anemia, abdominal tuberculosis, and other conditions may 

 simulate Addison's disease in many of their symptoms. 



On the other hand, failure to recognize Addison's disease 

 may often occur, particularly in those cases in which there is 

 no marked pigmentation. Cases of acute insufficiency of the 

 adrenals, to which the name Addison's disease is strictly speak- 

 ing not applicable, may also fail to be recognized. Thus, cases 

 of acute convulsive seizures, accompanied by low blood pres- 

 sure and respiratory irregularities, have been described in 

 which autopsy revealed marked adrenal injury as the only find- 

 ing to which the symptoms might be attributed. 473 Such 

 symptoms are obviously to be attributed to adrenal insuffi- 

 ciency. In other cases reported in the literature patients dying 

 suddenly under an anesthetic, for example, or of some unknown 

 cause are found at autopsy to have extensive adrenal disease 

 without having manifested the symptoms of Addison's disease 

 during life. In such cases we are dealing with latent forms of 

 the disease, suddenly aggravated by an operation, or with an 

 adrenal insufficiency which is marked by the co-existence of a 

 second disease. In the absence of pigmentation, one might 

 easily attribute the existence of asthenia, hypotension, etc. to 

 an active tuberculous process elsewhere, when in reality they 

 may result from disease of the adrenals. 



Calcification, demonstrable by the roentgenogram, is often 

 present in cases due to tuberculosis. 30 One must avoid being 

 misled by calcification of a lymph node or other adjacent 

 structure. 



The reaction of patients suffering from Addison's disease to 

 a sudden deprivation of salt has recently been suggested as a 

 diagnostic aid in doubtful cases. 485 Patients suffering from 

 Addison's disease may be thrown into a state of acute crisis by 

 subjecting them to a salt-free diet. This test must, therefore, 



