THE SYMPATHETIC SYSTEM 137 



ETIOLOGY. 



Adrenal insufficiency is usually observed in individuals 

 between 20 and 30. 



1. It may be the result of chronic lesions of the 

 adrenals: syphilis, cancer, and particularly tubercu- 

 losis. Tuberculosis is the most common cause of adrenal 

 insufficiency. It nearly always causes slow syndromes of 

 the disease, but as a result of the progressive extension 

 of the lesions it also causes acute syndromes. 



The tuberculous lesions of the adrenals are sometimes 

 latent and some individuals appear in perfect health at the 

 time they are suddenly overwhelmed with severe symp- 

 toms. In reality adrenal insufficiency already existed 

 in a latent form and it is often a minor factor : overwork, 

 traumatism (accidental or operative), an acute tonsilitis, 

 which cause new lesions in these already degenerated 

 glands. The healthy portions up to then sufficient, are 

 then destroyed. Again one of the causes already men- 

 tioned, introduces into the organism an excess of poisons 

 which the antitoxic function of the defective gland is 

 incapable of neutralizing; then the acute symptoms of 

 adrenal insufficiency develop. 



II. ADRENAL INSUFFICIENCY IS THE RESULT OF 

 AN ACUTE INFECTION: 



Diphtheria, typhoid fever and scarlet fever are three 

 diseases which most often cause it. 



(a) DIPHTHERIA. Certain sequels of severe diphtheria 

 described under the name of late infectious syndrome 

 (Marfan), cardio gastric syndrome (Sevestre) and believed 

 to be due either to a toxic myocarditis, or to a bulbar 

 lesion or to a neuritis of the vagus, but must be recognized 

 as an adrenal insufficiency. They are characterized by 



