132 ENDOCRINE GLANDS 



I. ADRENAL INSUFFICIENCY. 

 CLINICAL STUDY. 



This is characterized by three cardinal symptoms : 

 asthenia, arterial hypotension and the adrenal white line. 



1. ASTHENIA. According to the etiological factor, the 

 asthenia is very progressive or very abrupt. When pro- 

 gressive, it is characterized by a physical and intellectual 

 lassitude which can only be satisfied by rest and which the 

 patient cannot overcome by any effort of the will. This 

 lassitude soon changes to prostration and complete apathy. 

 The slightest effort causes such a sensation of fatigue and 

 is so painful, that the patient stays still in bed in a semi 

 sleep. He avoids speaking and only answers with diffi- 

 culty to the questions asked him ; does not want to eat so 

 as to avoid moving. This asthenia is not a subjective 

 sensation ; it is shown objectively with the dynamometer by 

 a marked decrease in the muscular strength in spite of the 

 fact that the patient does not show any paralytic symptoms. 



2. ARTERIAL HYPOTENSION. It indicates the failure 

 of the angiotonic action. This drop is manifested both in 

 the systolic and diastolic pressure. The pressure may 

 drop to 90 or 80 cr even below. It is very unstable, varies 

 from one minute to the other and reaches its lowest level 

 after fatigue or an effort. 



3. THE ADRENAL WHITE LINE (Sergent). The so- 

 called white line of Sergent is in a way the opposite of the 

 red line (tache) of meningitis. To bring it out all that is 

 necessary is to stroke the skin of the abdomen with a blunt 

 object or the soft part of the finger, without scratching or 

 exerting too much pressure. Very shortly will appear, on 

 the course followed on the skin, a white line, rather broad 

 which increases gradually, then stays stationary for a 

 certain length of time. 



