Clinical Syndromes due to 

 Suprarenal Diseases 



Addison's Disease 



BENSON A. COHOE 



PITTSBURGH 



Introduction 



A fundamental advance in the development of our knowledge of the 

 clinical aspects of the diseases of the ductless glands was made when 

 Thomas Addison (&), of Guy's Hospital, in 1855, published his classic 

 treatise, "On the Constitutional and Local Effects of Disease of the Supra- 

 renal Capsules." His observations upon an obscure clinical condition, 

 characterized by profound asthenia, severe gastro-intestinal disturbances, 

 and a peculiar bronzing of the skin, led to his discovery of the association 

 of this syndrome with a diseased condition of the suprarenal glands. The 

 concise definition of the clinical features of the disease, as portrayed by 

 Addison, comprises all the essentials : "The disease develops in the third 

 or fourth decade of life, usually quite insidiously, with adynamia and 

 apathy. To these are added disturbances of the digestive tract (constipa- 

 tion, often alternating with diarrheas), and pigmenting of the skin and 

 mucous membranes: the patients succumb under a gradually increasing 

 cachexia, not rarely with stormy terminal manifestations ; autopsy almost 

 always shows disease of both suprarenals, mostly tuberculous caseation." 



This important observation of Addison has had a far-reaching in- 

 fluence, not only upon clinical medicine, but upon the pre-clinical sciences 

 as well. The interest of the clinicians was quickly aroused into recogniz- 

 ing clinical forms of the disease, and into theorizing upon the obscure 

 underlying pathogenesis. Among the earlier physicians confirming the 

 observations of Addison were Wilks, Greenhow, Hutchinson, and Isaac 

 Taylor in America (1856). The caption "Addison's Disease" was first 

 employed by Trousseau (1856). Clinicians since the time of Addison 

 have contributed many facts concerning the clinical phenomena of the 

 disease, which have been co-ordinated by the labors of Neusser, Lewin, 



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