324 BENSON A. COHOE 



insufficiency, which are apparently of the same nature as the "shell shock" 

 cases of the English writers, Sajous and Pende are inclined to attribute 

 certain functional cardiopathies observed in soldiers to suprarenal ex- 

 haustion of neuropsychogenic origin. An adrenal form of asystole (asys- 

 tolie surrenale) has been described by Josue, characterized by an enlarged 

 heart with low arterial tension, and frequently complete arrhythmia and 

 auricular fibrillation, with sudden death. At autopsy the suprarenals 

 were found, in all of his four cases, to be extremely small or diseased, a 

 fact which led this writer to presume that the heart was suffering from 

 lack of physiologic stimulus supplied normally by the suprarenals. 



Other writers have attributed certain forms of gastropathies to hypo- 

 adrenia. Loeper has described a suprarenal dyspepsia (dyspepsie sur- 

 renale) manifested by atonicity and constipation, while Hernando has 

 stated, as a result of his research, that suprarenal insufficiency appears 

 to induce conditions favorable for the development of gastric ulcer. He 

 observed gastric ulcers in some cases of severe hypoadrenia. Suprarenal in- 

 sufficiency has been the alleged causative factor in many other clinical dis- 

 orders, such as manic-depressive psychosis (Rossi), and seasickness 

 (Naame). 



In many instances of reports in the literature concerning the occur- 

 rence of hypoadrenia in various disorders, the hypothesis of a suprarenal 

 origin of the syndrome has been assumed on the observation of the bene- 

 ficial results following the administration of suprarenal gland extract 

 or epinephrin. Clinicians have at times fallen into the error of 

 identifying the pharmacological action of the extract of the gland with 

 the physiological function of the suprarenal. There is, as a matter of 

 fact, little or no clinical or experimental evidence to warrant such assump- 

 tion, and much evidence distinctly controverts it. 



As has already been emphasized, the making of a positive diagnosis 

 of any form of hypoadrenia intra vitam is a difficult matter. It seems 

 possible, however, that in the more outspoken types of acute hypoadrenia, 

 associated with suprarenal hemorrhage, or acute epinephritis, a diagnosis 

 might justifiably be made. The abrupt onset of the condition, the lumbar 

 or epigastric pain, the rapid fall in arterial pressure, the severe gastro- 

 intestinal disorders (vomiting, diarrhea), and the grave collapse, should 

 arouse the suspicion of the physician as to the sudden failure of suprarenal 

 function. The clinical condition may be confused with that of acute 

 hemorrhagic pancreatitis. According to Lavenson's observation, the shock 

 is more profound, the lumbar tenderness more acute, and the epigastric 

 pain and vomiting less marked in acute hypoadrenia than is the case in 

 acute hemorrhagic pancreatitis. Acute hypoadrenia is also to be differ- 

 entiated from various acute poisonings. It has been mistaken in some 

 instances for peritonitis, appendicitis, cholera morbus, and cerebral 

 apoplexy. 



