CHAPTER VIII 



THE SUPRARENAL CAPSULES 



The suprarenal capsules or adrenals have received special attention, both 

 from clinicians and physiologists, since Addison (1855) described the 

 symptoms of the disease which bears his name and which he associated 

 with degeneration of these organs. Addison's disease is characterised by 

 great languor and general debility, with weakness and diminution of tone, 

 not only of the skeletal but of the vascular and visceral musculature, 

 feeble action of heart, loss of appetite, disturbance of the digestive tract, 

 severe abdominal pain, and extreme emaciation. Anaemia, which is an 

 occasional accompaniment of the disease, was regarded by Addison, when 

 it occurs, as symptomatic ; but it is probably the result not of the destruc- 

 tion of the capsules, but of the intercurrent affection (generally tuberculosis) 

 which has produced their destruction. The most striking characteristic of 

 the disease as described by Addison was undoubtedly the pigmentation 

 (bronzing) of the skin, which occurs as a diffuse colouration upon the face 

 and hands and other exposed parts, and is increased in regions where there 

 is some pigmentation normally present, such as the areolae of the nipples 

 and the external genital organs. It is also found on the mucous membrane 

 of the mouth and on that of the conjunctiva. Sometimes the bronzing 

 does not occur ; these cases are usually the more acute. The disease is 

 fatal. Its course may be prolonged, " even to six or ten years. In rare 

 instances recovery has taken place, and periods of improvement lasting 

 many months may occur" (Osier). Some cases are markedly benefited 

 by administration of suprarenal extract per os or hypodermically ; others 

 not at all. 



The cause of the excessive formation of pigment is not understood, but 

 it has been suggested (by Adami and others) that adrenalin may be derived 

 from the same source as the melanin of the skin, and that if the formation 

 of adrenalin is interfered with an excess of melanin is formed and deposited. 

 Meirowsky states that in portions of skin removed from patients who have 

 died of Addison's disease an increase of pigment occurs as long as five days 

 after death if the pieces are kept in a warm, moist chamber, but that this 

 does not occur in skin from those who have died from other causes. 

 He suggests that a colourless precursor of the melanin is present in the 

 skin, and supposes this to become transformed under the influence of light. 

 Somewhat similar observations have been made by Konigstein, and by 

 Biedl and Hofstatter, on the skin of dogs deprived of their suprarenal 



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