MHU SOX'S DISEASE 613 



the ))()ssil)ility that (ivci'sccrct ion of ('])iii('|)hi'iii may be a cause of 

 artei'iosclcrosis, I)iit tlici'c is no evidence tliat this actually occurs in 

 man. 



ADDISON'S DISEASE i ' 



As pointed out bel'oi'c, the ])i-ot'oun(l deficiency in the de])rossor prin- 

 ciples evident in the manifestations of Addison's disease implies loss 

 of function, not only of the adrenal medulla, but also of the rest of 

 the chromaffin tissues which produce this same sort of material. 

 Therefore it is possible to have any amount of destruction of the ad- 

 renals without Addison 's disease, if there is sufficient compensation 

 by the other chromaffin structures, or, conversely, Addison's disease 

 may occur when the adrenals seem morphologically little altered, which 

 occurs in about 10 per cent, of all cases. In typical cases, however, 

 the adrenals have been found entirely devoid of epinephrin,-" and 

 usually the structural alterations are conspicuous. While some have 

 held that the destruction of the adrenal cortex is of importance in Ad- 

 dison 's disease, this does not seem to have been conclusively demon- 

 strated. 



The pifi-mentation of the skin -^ has not yet been explained, but in 

 view of the fact that oxidizing enzymes readily convert epinephrin, 

 tyrosine, and related aromatic substances into pigments, and that in 

 Addison's disease we have a deficiency in a tissue which is known to be 

 concerned in the metabolism of aromatic compounds, it seems probable 

 that the pigmentation is the result of this defective metabolism of the 

 chromogenic aromatic compounds. In support of this view is the ob- 

 servation of Bittorf -^^ that the skin of persons with Addison's disease 

 has an augmented power of oxidizing epinephrin and tyrosine to pig- 

 mented substances. Until the pigment of Addison's disease has been 

 isolated and analyzed, however, this hypothesis will probably remain 

 an hypothesis. (See pigmentation. Chap, xvi.) Addison's disease 

 can occur without pigmentation. 



That there is a deficiency in the formation of epinephrin is at- 

 tested by the low blood pressure and general low tone of the unstri- 

 ated muscle tissue. Carbohydrate metabolism is also altered, Porges -- 

 having found hypoglucemia in Addison's disease, and an increased 

 sugar tolerance having been observed by others. Whether the ad- 

 renals exert a detoxicating eflfect, and the symptoms of the disease 

 are partly the result of an autointoxication of some sort, is at present 

 unknown, although this idea has often been advanced. The general 



19 LitfM-aturo on Clicinistrv, bv Eiselt, Zeit. klin. ^[ed., 1010 (60), 303. 



20 Inkier and Schniorl. Dent. Arcli. klin. Mefl., 1011 (104), 12ri. 



21 Aooordin<r to Straiib (Dent. Arch. klin. 'Mod., 1000 (07). 67) pigmentation 

 may occur within 17 da^•a after thrombosis of tlie adrenal vein. 



2'iaArch. exp. Path., 1014 (75), 143. 



22 Zeit. klin. :Med., 1000 (60), .341; also Bernstein, "nerl. klin. Woch.. 1011 (4S), 

 1794. Normal blood sugar was found bv Broekmever, Deut. nied. ^N'och., 1014 

 (40), 1562. 



