618 CHEMICAL PATHOLOGY OF THE DUCTLESS GLANDS 



in the muscle, perhaps at the nerve endings. But it is a fact of much 

 practical importance that administration of epinephrine will not 

 compensate successfully for the loss of the adrenals, whether because 

 the gland secretes other things, or because the intermittent artificial 

 administration of the epinephrine will not compensate for the regulated 

 secretion of the gland under normal conditions, or both. It would 

 seem that the adrenal has an effect on other glands, for injections of 

 epinephrine cause glycosuria in animals, as also does manipulation of 

 the adrenals, or painting the epinephrine on the pancreas. There is 

 much disagreement as to the effects of extirpation of the adrenals on 

 carbohydrate metabolism, and the nature and cause of the effects 

 observed. Biedl sums up the evidence with the statement that the in- 

 ternal secretion of the chromaffin system is of importance in the mobi- 

 lization of the sugar of the blood, and the formation of the glj^cogen 

 in the tissues. That the adrenal is at all implicated in human diabetes 

 has not been demonstrated. There seems to be a relationship of mu- 

 tual stimulation between thyroid and adrenal, for thyroid secretion 

 sensitizes the sympathetic nerve endings to epinephrine, and both 

 liberate carbohydrates from the sugar depots. ^^ 



Acute insufficiency of the adrenals, caused most often by hemor- 

 rhagic infarction, but sometimes by other lesions, may cause sudden 

 collapse, asthenia or death." The extent to which the cortex and 

 medulla respectively are responsible is undetermined. The French 

 authors especially lay great weight on adrenal insufficiency as a cause 

 of pathological states. ^^ Surgical shock has also been attributed, at 

 least in some cases, to exhaustion of the adrenals, which takes place 

 under the influence of the anesthetic and the stimulation to the nervous 

 system by the operative manipulation, perhaps augmented by concur- 

 rent infections.''^ 



It is possible that in some cases of trauma to the adrenal, acute 

 hemorrhage or infection, intoxication from an excess of epinephrine 

 might occur, but it is improbable that fatal results could be produced 

 in this way, for the lethal dose for dogs and rabbits is about 0.1 to 0.25 

 mg. per kilo, and the two adrenals in man contain in all but about 

 4 to 5 mg. epinephrine. Moderna, however, states that there is so 

 much epinephrine set free after hemorrhage into the adrenal, that it 

 can be demonstrated microchemically in the liver, and that the symp- 

 toms and autopsy findings are identical with those of acute epinephrine 

 intoxication. In animals, repeated doses of epinephrine produce 

 decreasing effects, not only on blood pressure but on the glycosuria and 

 other symptoms, indicating an acquirement of tolerance, but, because 



«" See Endocrinology, 1917 (1), 40-4. 



"Literature by Lavenson, Arch. Int. Med., 190S (2), 62; Materna, Ziegler's 

 Beitr., 1910 (48), 236. 



"8 See Sergcnt, Presse M6d., 1909 (17), 489; Cowie and Beaven, Arch. Int. 

 Med., 1919 (24), 78. 



""See Ilornowski. Arch. m6d. exp6r., 1909 (21), 702; Virchow's Archiv., 1909 

 (198), 93. 



