324 CLINICAL CONSIDERATIONS 



be applied cautiously and any untoward reaction promptly 

 counteracted by the administration of liberal amounts of the 

 cortical hormone and salt. 351 



The therapeutic test should prove of value in the future for 

 arriving at a diagnosis in doubtful cases. The results of ther- 

 apy with the adrenal cortical hormone should indicate whether 

 adrenal insufficiency is the source of the observed clinical mani- 

 festations. Such a therapeutic test may also prove to be a 

 means of detecting the disease in its early stages. 



TREATMENT 



The history of the therapeutic management of Addison's 

 disease has been one of repeated disappointments. False 

 hopes of cure have been inspired by the natural remissions 

 which characterize the disease. Many modes of therapy and 

 reports of cures have been reported, from the case described by 

 Addison as ostensibly cured by brandy to the cases of recent 

 years ostensibly revived by adrenal extracts. Many apparent 

 cures resulted from an original error in diagnosis as in the patient 

 reported cured by an adrenal graft, but who at autopsy was 

 found to have had no disease of the adrenals and no success- 

 fully grafted adrenal tissue. 



Irradiation of the diseased adrenals has been tried with no 

 success. Removal of a tuberculous gland in the early stage of 

 the disease would be indicated (as in renal tuberculosis) but 

 unfortunately the symptoms of Addison's disease do not mani- 

 fest themselves until the disease has affected both glands. 

 With a supply of the adrenal cortical hormone available to 

 carry the patient through an operation, it may be that future 

 developments in surgery will make it possible to remove the 

 diseased portion of the glands and leave bits of the remaining 

 healthy tissue to hypertrophy or transplant them to new sites. 

 The absence of any method by which mild degrees of cortical 

 insufficiency can be detected prevents early recognition and 

 treatment of the disease in its early stages. The discovery 



