348 THE DISEASES OF THE SUPRARENAL APPARATUS 



are also frequent in scleroderma. From this we must not conclude that a 

 complication of scleroderma with Addison's disease is present in the indi- 

 vidual cases as pigmentations belong to scleroderma as such. Also similar 

 pigmentations are observed in pellagra (v. Neusser). Statements as to the 

 characteristic erythema in the warm seasons of the year clinch the diagnosis 

 in this case. Arsenic melanosis and argyrosis show another tint. Pigmen- 

 tations are also observed in leucemia. v. Neusser thought that there were 

 leucemic infiltrations of the suprarenals, which opinion a case of Zeigler's 

 later corroborated. Pigmentations in Basedow's disease are very common. 

 The complication with Addison's disease is very rare. However, such 

 cases in which the diagnosis was confirmed by autopsy have been reported 

 by Fletcher, and by Greenhow. Such a diagnosis should be made in vivo with 

 great caution, as markedly pigmented cases of Basedow's disease with 

 cachectic symptoms such as occur in the latter stages can easily give rise 

 to the impression of a concomitant Addison's disease. 



Very difficult is the delimitation from cachectic conditions associated with 

 occult carcinomas and diseases of the liver, in which diseases melanoplakia 

 of the oral mucous membrane may occur also (Schultze) . In these cases and 

 in the case of Addisonoid anemias described by Grawitz, the demonstration 

 of a hypoglycemia and of a mononucleosis. with hypereosinophilia is very 

 important. 



The diagnosis of acute Addison's disease may be very difficult. Brodnitz 

 points out the importance of the following syndrome: Extraordinary slow- 

 ing of the fully tense pulse with normal temperature; violent intestinal colics 

 occurring in attacks; failure of the peristalsis and isolated intestinal disten- 

 tion. Brodnitz believes that thrombosis of the suprarenal vein occurs in 

 many cases of postoperative spastic occlusion of the intestine. 



The prognosis of Addison's disease is always very dubious. The few 

 certain cases of cure concern mostly luetic disease of the suprarenal, some 

 with and some without specific treatment (Merckel and Birch-Hirschfeld)', 

 in a case of Oesterreicti 's the extirpation of the one tuberculous suprarenal led 

 to cure. Cure has also been observed in cases of hypernephroma with 

 Addisonian manifestations (Bittorf). 



Treatment. It remains to be said that treatment is very ineffective. 

 The statements as to improvement after subcutaneous or peroral adminis- 

 tration of suprarenal substance are more sparse than those concerning results 

 that are negative. The administration of small doses of adrenalin per os is 

 ineffective, as might be gathered from our researches, which show that even 

 more than 20 mg. per day do not call forth any especial manifestations. 

 Only when the doses are very much larger did we see in animals after admin- 

 istration for days the occurrence of hyperglycemia (Falta and Turin}. I 

 quote one of our experiments: 



