THE SYMPATHETIC SYSTEM 145 



disease, but not the only one (cancer or syphilis may also 

 be the etiological factor). 



3. Adrenal tuberculosis and Addison's disease are not 

 synonymous, since, as we have just seen that tuberculosis 

 of the adrenals manifests itself by a syndrome of adrenal 

 insufficiency without any melanodermia. 



SYMPTOMS. 



We will use as an example a case of Addison's disease of 

 tuberculous origin. This condition is nearly always 

 primary and occurs in individuals between 15 and 30 w^ho 

 may previously have evidence of tuberculosis, but as a 

 rule no active pulmonary lesion. 



The onset is very insidious: Feeling of lassitude, weak- 

 ness, loss of strength, are the first manifestations which 

 are noticed by the patients ; then the symptoms become 

 more definite and the disease as it progresses begins to 

 show evidences of adrenal insufficiency; asthenia, arterial 

 hypotension, white line, circulatory disturbances, gastro 

 intestinal symptoms, lumbar pains; all signs of deficiency 

 of the glandular function. 



The most characteristic sign is the melanodermia. It 

 usually does not appear until after the asthenia has set in. 

 It nearly always starts in the regions already, pigmented, 

 such as, the genital folds at the level of the hips, on the 

 internal surfaces of the arms and around the breasts, then 

 it becomes generalized and manifests itself in the regions 

 exposed to the air; the face, the neck, the back of the 

 hands. It is often more marked at the beginning of 

 the disease in the regions irritated by rubbing such as, by 

 a collar, corsets, etc., and at the level of scars, burns, etc. 

 These irritated spots of the skin are the usual starting 

 points of the pigmentation and it is by basing themselves on 



this fact that Jacquet and Tremolieres have suggested 



10 



