136 ENDOCRINE GLANDS 



patient dies in a few days, or sometimes immediately, 

 following some slight movement in bed of cardiac failure. 

 These cardio intestinal types which are the result of an 

 acute adrenal insufficiency, simulate poisoning or cholera. 

 (6) In some cases the symptoms consist in vomiting 

 with severe constipation and abdominal pain. The ab- 

 domen is hyperesthetic and distended with gas. Often 

 an appendicitis or peritonitis is suspected; whence the 

 name of pseudo peritonitis or syndrome of Ebstein. The 

 patients die shortly afterwards. 



(B) NERVOUS TYPE. Adrenal encephalopathy of Sergent. 

 In certain cases adrenal insufficiency takes on a nervous 



symptomatology : 



Comatous phenomena, which are rapidly fatal and simu- 

 late apoplexy. 



Convulsive phenomena or myoclonic movements. 



Delirium (Laignel-Lavastine). 



Pseudo meningitis (Sergent). In these cases the 

 encephalitis, the rigidity of the neck, the cutaneous hyper- 

 esthesia, the photophobia, the opisthotonos, the delirium, 

 associated with vomiting and constipation, give the 

 picture of meningitis. Kernig's sign, is however, missing 

 and the spinal fluid remains normal. 



(C) SUDDEN DEATH. All the preceding types of 

 cases can end by sudden death. It may happen any 

 time during the evolution of a slow or acute adrenal 

 insufficiency. It is sometimes the only manifestation of 

 this insufficiency and really is an acute form of adrenal 

 insufficiency. Death is often instantaneous, following 

 some simple movement. It can sometimes be preceded 

 by an extreme dyspnea, the duration of which is, how- 

 ever, of more than a few minutes, with pallor of the face, 

 precordial pain, or an epiliptiform convulsion. 



