322 BENSON" A. COHOE 



satti (c), Ellidtt and Tuckett), but in other instances a normal epinephrin 

 index, or one slightly helow normal, has been observed in certain infec- 

 tions, as typhoid, septicemia, arid peritonitis (Sydenstricker). A marked 

 reduction or disappearance of the cholesterin bodies appears to be a con- 

 stant finding. The suggestion has been made that increased secretory 

 activity of the suprarenals occurs during infections as a protective mechan- 

 ism, and that a mobilization of the cholesterin bodies is related to the 

 presence of the toxins in the circulation. Ragazzi, however, believes that 

 the disappearance of epinephrin in infections is not the result of a chemi- 

 cal reaction between that substance and a toxin, but rather an indication 

 of glandular insufficiency caused by bacterial lesions of the parenchyma. 



The functional type of hypoadrenia has proved of special interest 

 to endocrinologists. The term functional is employed to distinguish this 

 form of glandular insufficiency from the other types in which, apart from 

 any developmental defect or dysfunction which may be present, there is 

 superimposed secondary organic alterations in the gland substance, in 

 the form of destructive lesions. Sajous(a) has defined this type as the 

 symptom complex of deficient activity of the suprarenal glands, due to 

 inadequate development, exhaustion by fatigue, senile degeneration, or 

 any factor that, without producing organic lesions in the organs or their 

 nerve paths, is capable of reducing their secretory activity. 



The symptom complex of functional hypoadrenia is less readily cir- 

 cumscribed than those of the acute and terminal forms. The clinical 

 manifestations which have been ascribed by various writers to the func- 

 tional type embrace a wide variety of somatic and psychic disturbances. 

 The main symptoms include: asthenia, physical and mental; undue fati- 

 gability ; cardiac insufficiency ; feeble pulse ; arterial hypotension ; occasion- 

 ally arrhythmia or bradycardia ; vasomotor disturbances (sensitiveness to 

 cold, cold extremities, occasionally a hyposphyxia" with venous stasis, or 

 slight cyanosis of . extremities) ; gastrointestinal disturbances (dyspepsia, 

 anorexia, vomiting, hyperchlorhydria, constipation) ; psychic disturbances 

 (apathy, aboulia, faulty inhibition) ; drowsiness or insomnia; headaches; 

 paresthesias ; faulty metabolism. The symptoms in the individual case 

 may be mild or relatively severe in character, and only a few of the group 

 present. The duration of the syndrome is essentially chronic, but, if due 

 to a temporary exhaustion of the gland, may be more or less transient. 



It is now believed that many of the cases of functional hypoadrenia are 

 due to a congenital inferiority of the chromaphil system. A high grade 

 of defective development of the suprarenal glands is known to be fre- 

 quently associated with a faulty growth of the brain (anencephaly and 

 hemicephaly) and is incompatible with life. The suprarenal cortex de- 

 velops early in the embryo, and is relatively large in the fetus. Chauf- 

 fard found that as the gland increases in size in the fetus an increase in 

 the cholesterol content takes place until at birth the average content is 15 



