ADDISON'S DISEASE 299 



Rudinger, and Falta(c) have noted a high tolerance for grape sugar, and 

 the absence of glycosuria following epinephrin injection. Mussio-Fournier 

 found a high sugar tolerance in a patient with an atypical form of the 

 disease, in which case glycosuria failed to appear after the ingestion of 

 200 gm. of glucose, and after the injection of 3 nag. of epinephrin. Schles- 

 inger has confirmed the absence of glycosuria following epinephrin in- 

 jection. Rutelli has observed that the appearance of glycosuria following 

 epinephrin injection may be considerably delayed in a patient with Ad- 

 dison's disease, as compared with a healthy subject. 



Course. The more typical cases of the disease pursue, almost al- 

 ways, a chronic course, with an average duration of from two to four years. 

 The symptoms progress slowly, and the mode of progress, as Greenhow 

 pointed out, may be paroxysmal, with alternating remissions and exacer- 

 bations. During the intermissions the bodily strength may be to some ex- 

 tent restored, with an amelioration of all the symptoms, but following 

 each exacerbation, the symptoms become progressively more severe. Ex- 

 tremely chronic types of the disease have been reported, in which, with 

 the periods of remissions and intermissions, the patients have lived for 

 ten, or as long as twenty, years from the onset of symptoms. The more 

 chronic types are usually associated with an uncomplicated tuberculosis 

 of the suprarenals. The progress of the disease is more rapid, as a rule, 

 in cases due to atrophy of the glands. Not infrequently, chronic cases, 

 running a mild course for a long period, suddenly develop acute symp- 

 toms, and terminate fatally within a few days or weeks, or conversely, in 

 rarer instances, the disease may begin acutely, with severe gastro-intestinal 

 disorders, and subside into the chronic type. In the acute form of the 

 disease a very rapid course may be run. In a case reported by Motzfeldt 

 death occurred in two months, and in one reported by Mann (without 

 characteristic symptoms) in four weeks. Sergent and Bernard, as well 

 as Tieken, have described cases in which a fatal ending occurred in ten 

 days from the time of onset of acute symptoms. Karakascheff has re- 

 ported a still more rapid case, the patient dying within five days, due to 

 a thrombosis of one suprarenal, and a recent infarction of the other. The 

 acute cases of the disease have usually been found associated with de- 

 struction of the glands by hemorrhage, or thrombosis, and one or more 

 of the cardinal symptoms are frequently wanting, especially the pig- 

 mentation, although the gastro-intestinal symptoms may be acute. Some 

 of the acute cases reported in the literature, under the caption Addison's 

 disease, might more properly be classified as cases of acute hypoadrenia. 

 In children the disease commonly runs a rapid course with severe gastro- 

 intestinal symptoms. In any type of the disease death may occur sud- 

 denly, from a syncopal attack, or from exhaustion following uncontrollable 

 vomiting or diarrhea. In the chronic type the fatal termination may come 

 slowly and gradually, usually accompanied, or preceded by, more or 



