THE Ainn:\.\i.s A\D .\nn/s()\-s disease 611 



secivtion of the ^laiul uiidfi' normal conditions, or both. It would 

 seem tliat tlie adrenal has an elt'ect on other glands, for injections of 

 epinephrin cause glycosuria in animals, as also does manipulation of 

 the adrenals, or i)aiiitiii^- llie epinephrin on the pancreas. There is 

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

 carbohydrate metabolism, and the nature and cause of the effects ob- 

 served. Jiiedl sums up tlie evidence with the statement that the in- 

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

 bilization of the sugar of the blood, and the formation of the glycogen 

 in the tissues. That the adrenal is at all im})licated in human diabetes 

 has not been demonstrated. 



Acute insufficiency of the adrenals, caused most often by hemorrhagic 

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

 asthenia or death.'" The extent to which the cortex and medulla re- 

 spectively are responsible is undetermined. The French authors espe- 

 cially lay great weight on adrenal insufficiency as a cause of patho- 

 logical 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 hy concurrent in- 

 fections. '- 



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

 orrhage or infection, intoxication from an excess of epinephrin 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. epinephrin. IModema, how^ever, states that there is so much epi- 

 nephrin set free after hemorrhage into the adrenal, that it can be dem- 

 onstrated microchemically in the liver, and that the symptoms and 

 autopsy findings are identical with those of acute epinephrin intoxica- 

 tion. In animals, repeated doses of epinephrin produce a decreasing 

 effect, not only on blood pressure but on the glycosuria and other symp- 

 toms, indicating an acquirement of tolerance, but, because of its non- 

 protein nature, epinephrin does not cause the production of anti- 

 bodies.'^ 



IMany studies have been directed to determine the relation of the 

 adrenal to hypertrophy of the heart and to interstitial nephritis with 

 high blood pressure. Some have found more or less increase in size in 

 the adrenals under these conditions, chiefly involving the cortex, and a 

 slight increase in the epinephrin content has been reported, but it is 



10 Literature bv Lavenson, Areh. Int. ^Med., inOS (2), 62; Materna. Ziejiler's 

 Beitr., 1910 (48)', 236. 



11 See Sergent, Presse 'SUd.. HlOO (17), 480; S^zary, Semaine :M^d.. 1012 

 (33), 61. 



12 See Hornowski. Arch. nied. exper.. l!)()0 (21), 702; Virohow's Arcliiv., 100!) 

 (108), 03. 



13 See Elliott and Durham, Jour, of Physiol., 1006 (34), 430. 



