140 ENDOCRINE GLANDS 



involvement. Cyanosis, congestion of the lungs, the 

 increase in the size of the liver, are more indicative of 

 a myocarditis. 



3. The acute adrenal insufficiencies occurring without 

 any definite etiology can simulate: poisoning (voluntary 

 or accidental), enteritis, intestinal obstruction, appendi- 

 citis and acute pancreatitis. When nervous symptoms 

 are present it may simulate apoplexy, coma or meningitis. 



4. When the abdominal or nervous symptoms, consti- 

 tute, together with sudden death, the only signs of adrenal 

 insufficiency, it is impossible to make the diagnosis during 

 life. We must remember that lesions of the adrenals are 

 frequently found in sudden deaths. For this reason in 

 any medico legal case, the state of the adrenals must be 

 carefully investigated, for certain incidents, such as, trau- 

 matism, surgical operations, might seem to be the cause 

 of death, while in reality the patient had had a latent 

 adrenal insufficiency unsuspected during life. 



PATHOLOGICAL ANATOMY. 



At autopsy of patients having died from the results of a 

 slow adrenal insufficiency, many different types of adrenal 

 lesions have been found, in particular tuberculous lesions, 

 which will be studied with Addison's disease. 



Acute insufficiency is determined by different kinds 

 of lesions: 



1. HEMORRHAGES OF THE ADRENALS. These are very 

 frequent in infectious diseases. They are more often 

 bilateral and vary from punctiform hemorrhages to 

 massive ones; the gland is swollen, dark red in color and 

 showed on incision a marked congestion and hemorrhages 

 visible to the naked eye in the cortex. In severe cases 

 they are changed into hematoma, barely surrounded by a 

 shell of cortical tissue. Some cases have even been 



