286 THE INTERNAL SECRETIONS 1920 



acute adrenal irritation ; and the adrenal irritation in 

 angioneurotic edema appears never to be of a type 

 severe enough to overcome local vasodilation until the 

 local vasodilators are paralyzed through fatigue. Yet, 

 once local vasodilator paralysis has occurred, adrenal 

 support of the unopposed vasoconstriction results in a 

 severe and long-continued angiospasm and interruption 

 of the circulation in the involved area, the end product 

 of which is a large, persistent wheal the true lesion of 

 angioneurotic edema. All evidence, therefore, points to 

 a primarily predominating vasodilator irritability 

 (hyperthyroid phenomenon) to which has been added a 

 powerful continuing constricting impulse (hyperadre- 

 nal phenomenon) as being the direct causes of angio- 

 neurotic edema. 



These facts and circumstances show conclusively the 

 endocrine factor in angioneurotic edema, and appear to 

 the author to reveal thyro-adrenal irritation as the real 

 cause thereof. Neuromuscular fatigue of the vessel 

 walls appears to be merely an incidental circumstance 

 which makes possible localized vessel-wall permeability 

 and the resultant serum oozing. The cause of aug- 

 mented vasodilation and reenforced vasoconstriction 

 logically must be the real cause of this disorder, which 

 might better be known as "Thyro-Adrenal Urticaria," 

 a pluriglandular hypersecretory syndrome. 



An added evidence of the predominance of adrenal 

 hypersecretion in this condition lies in the uniform ex- 

 istence in angioneurotic edema of a lowered sugar toler- 

 ance and a glycosuria of small degree. Animal experi- 

 mentation has shown (8) that extreme glycosuria may 

 be produced by adrenin injections. 



Treatment: The treatment should be that of mild 

 hyperthyroidism and lowered sugar tolerance, plus free 

 elimination, alkalies to restore the normal alkali re- 

 serve, a large fluid intake, local sedation, and physical 

 and mental rest. Many patients are particularly sen- 



