Chronic Adrenal Insufficiency Research Articles

Papilledema associated with increased intracranial pressure in Addison's disease.

Papilledema associated with increased intracranial pressure in patient with Addison's disease. Spinal fluid pressure determinations and ventriculography not undertaken. Ultimate disappearance of choking. Thrombosis of intracranial dural sinuses probable explanation for ocular signs. L. S. (J.H.H.560011), a white woman aged 20, had been anemic for five years after severe pyelonephritis. She had complained of episodes of headache, associated with vomiting, and excessive weakness for five months before she was seen by us at the Johns Hopkins Hospital. Three months prior to our examinations it had been recognized that the patient had Addison's disease (chronic adrenal insufficiency), and she had been given desoxycorticosterone acetate (percorten®). During this time, because of severe headaches with vomiting, she had been twice admitted to the hospital. On the last such admission she had been given two blood transfusions and had not evidenced any immediate reaction to the transfusion. Her eyegrounds were said to be normal

Hyperadrenocorticism

The most classic manifestations of hyperadrenocorticism are found in Cushing's syndrome and the adrenogenital syndrome. Dramatic results can be obtained in the treatment of these patients when the main pathogenetic factor is an adrenal tumor, which is satisfactorily removed in its entirety. In Cushing's syndrome due to adrenal hyperplasia excellent results have been obtained in some patients following bilateral subtotal adrenalectomy. The prospects of surgical therapy for hyperadrenocorticism loom much brighter with the provision of an abundant supply of cortisone for the treatment of acute and chronic adrenal insufficiency that may be complications of surgery. Testosterone therapy is of some advantage in the treatment of Cushing's syndrome and cortisone in the adrenogenital syndrome. Far more common than either of these syndromes is a miscellaneous group of patients with certain manifestations, but with a course that is quite different. The pathogenesis, pathologic physiology and rationale of therapy for this larger group of patients is much less clearly understood.

Addison's disease in a five and one-half year old boy.

Chronic adrenal insufficiency (Addison's disease) is extremely rare in the pediatric age group. In the approximately 100 such cases that have appeared in the literature to date, less than one fourth of the patients were children under 10 years of age. 1 Adrenocortical tuberculosis was etiologically responsible for the majority of cases, whereas a smaller percentage was ascribed to bilateral adrenal cortex atrophy, agenesis or degeneration of unknown origin and hyperplasia of the adrenogenic zone of the cortex. Other etiologic factors responsible for the destruction of the adrenal cortex and the syndrome of Addison's disease in adults, namely, pyogenic abscesses, vascular lesions, mycosis fungoides, echinococcic cysts, amyloidosis, neoplasms, histoplasmosis, moniliasis and diphtheria, have not been demonstrated in children. 2 Because of the relative rarity of Addison's disease in infancy and early childhood, the following case of the disease due to bilateral adrenal cortex atrophy in a 5½ year old boy

Changing pathogenesis of Addison's disease, with special reference to amyloidosis.

THE DISTURBANCES in electrolytic equilibrium, in water balance and in the metabolism of carbohydrates and pigments which are observed in Addison's disease are known to reflect adrenocortical hypofunction. This, in turn, is dependent on severe retrogressive changes in the adrenal glands, often terminating in extensive bilateral destruction. Various etiologic processes have been incriminated in the production of the structural alterations. Review of 2,550 autopsy protocols by Philpott 1 in 1928 (University Hospital, Ann Arbor, Mich.) disclosed 14 cases with morphologic features providing a basis for chronic adrenal insufficiency. In 7 the lesions were due to tuberculosis and in 4 to metastatic carcinoma. Of the remaining 3 cases, 1 was ascribed to mycosis fungoides, 1 to simple atrophy and 1 to amyloidosis. Today, twenty-two years later, it seems worth while to study the subsequent 9,000 postmortem records to determine whether the same etiologic factors are operative and, if so, to learn

THE SPECIFICITY OF THE “WATER TEST“ AS A DIAGNOSTIC PROCEDURE IN ADDISON'S DISEASE1

IN 1941 two procedures to assist in the recognition and exclusion of Addison's disease were described by Robinson and two of us [Power and Kepler (30)]. These procedures have since become known as the “water test.” It is the purpose of this review to consider the rationale of the test and to evaluate it specificity in the diagnosis of chronic adrenal cortical insufficiency. Data obtained at the Mayo Clinic during the period from January, 1941, to May, 1945, inclusive, have been utilized. The two procedures which comprise the “water test” were considered separately and in combination. I. DESCRIPTION OF TESTS AND INTERPRETATION The following description and interpretation of the water test are reproduced in part from the original article of Robinson, Power and Kepler (30). Procedure I (based on volume of urine).—On the day before the test the patient eats three ordinary meals but omits extra salt. He is requested not to eat or drink anything after 6 p.m. Until this time he may drink water as desired. At 10:...

ACUTE INSUFFICIENCY OF THE ADRENAL GLANDS; REPORT OF 2 CASES

Excerpt The Syndrome of chronic adrenal insufficiency has received considerable attention in the literature in the past decade due to increased knowledge of the pathologic physiology and improvemen...

Chronic Adrenal Insufficiency and Pancreas Diabetes.

Grollman and Firor1 have demonstrated that chronic adrenal insufficiency, induced by various methods, is primarily a disturbance of pituitary origin. The syndrome which follows, cessation of growth, failure of reproductive activity and subnormal body temperature is, according to the above workers, relieved by administration of pituitary extracts and not by cortin. Long2 has shown that acute adrenal insufficiency caused by the removal of the adrenal gland, though accompanied by injections of cortin, ameliorates experimental pancreatic diabetes. The object of the present experiments is to determine the effects of chronic adrenal insufficiency on the course of experimental pancreatic diabetes.Eight cats were anesthetized with sodium pento1)arl)ital and both lumboadrenal veins were ligated distally and proximally to the gland. L4t the same time the entire pancreas was removed. The animals received neither insulin nor cortin. Fluid was given ad lib. along with a Lveighetl amount of food (Bovex) each day. The p...

DISTURBANCES OF THE ENDOCRINE BALANCE AND THEIR RELATION TO DISEASES OF METABOLISM

Article1 June 1936DISTURBANCES OF THE ENDOCRINE BALANCE AND THEIR RELATION TO DISEASES OF METABOLISMC. N. H. LONG, M.D., D.SC.C. N. H. LONG, M.D., D.SC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-9-12-1619 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptLast year it was my privilege to address the College upon the subject of carbohydrate metabolism and the implications that recent work in this field had upon our knowledge of diabetes mellitus.Since this address appeared to meet with a certain measure of approval from you, I have ventured this evening to speak again upon certain pieces of work that to my mind are significant to those of us whose interest is concerned with the so-called diseases of metabolism.It appears to me that it is becoming more and more apparent that the clinical condition that follows hypo- or hyperfunction...Bibliography1. CROOKERUSSELL ACDS: The pituitary gland in Addison's disease, Jr. Path. and Bact., 1935, xl, 255. CrossrefGoogle Scholar2. GROLLMANFIROR AWM: Rôle of the hypophysis in experimental chronic adrenal insufficiency, Am. Jr. Physiol., 1935, cxii, 310. CrossrefGoogle Scholar3. ZECKWERDAVISONKELLERLIVINGOOD ILWTBBS: The pituitary in experimental cretinism. I. Structural changes in the pituitaries of thyroidectomized rats, Am. Jr. Med. Sci., 1935, cxc, 145. CrossrefGoogle Scholar4. FRY HJ: The pituitary gland in diabetes mellitus and disorders of the glands of internal secretion, Quart. Jr. Med., 1915, viii, 277-299. CrossrefGoogle Scholar5. KRAUS EJ: Hypophyse und Diabetes mellitus, Virchow's Arch. f. path. Anat., 1920, ccxxviii, 68-133. CrossrefGoogle Scholar6. HOUSSAYBIASOTTI BAH: Hypophysis, carbohydrate metabolism and diabetes, Endocrinology, 1931, xv, 511. CrossrefGoogle Scholar7. MANNMAGATH FCTB: The effect of removal of the liver after pancreatectomy on the blood sugar level, Arch. Int. Med., 1923, xxxi, 797. CrossrefGoogle Scholar8. YATERMARKOWITZCAHOON WMJRF: Consumption of sugar by muscle in the non-diabetic and diabetic state, Arch. Int. Med., 1933, li, 800. CrossrefGoogle Scholar9. CAMPOSCURUTCHETLANARI CAJLA: Rôle du foie dans l'action diabétogène du lobe glandulaire de l'hypophyse de crapaud, Compt.-rend. Soc. de biol., 1933, cxiii, 467. Google Scholar10. LONGLUKENS CNFD: The effect of adrenalectomy and hypophysectomy upon experimental diabetes in the cat, Jr. Exper. Med., 1936, lxiii, 465. CrossrefGoogle Scholar11. BESTFERGUSONHERSHEY CHGCJM: Choline and liver fat in diabetic dogs, Jr. Physiol., 1933, lxxix, 94. CrossrefGoogle Scholar12. ALLEN FM: Glycosuria and diabetes, 1913, Harvard University Press. CrossrefGoogle Scholar13. DAVISCLEVELANDINGRAM LDWR: Effect of hypothalamic lesions and stimulation of autonomic nervous system upon carbohydrate metabolism, Arch. Neurol. and Psychiat., 1935, xxxiii, 592. CrossrefGoogle Scholar14. CROOKE AC: A change in the basophile cells of the pituitary common to conditions which exhibit the syndrome attributed to basophile adenoma, Jr. Path. and Bact., 1935, xli, 339. CrossrefGoogle Scholar15. HIMSWORTH HP: (a) Physiological activation of insulin, Clin. Sci., 1933, i, 1. (b) Dietetic factors influencing glucose tolerance and activity of insulin, Jr. Physiol., 1934, lxxxi, 29. (c) Influence of diet on sugar tolerance of healthy men and its reference to certain extrinsic factors, Clin. Sci., 1934, i, 251. (d) Dietetic factor determining glucose tolerance and sensitivity to insulin of healthy men, Clin. Sci., 1935, ii, 67. (e) Diabetes mellitus: its differentiation into insulin-sensitive and insulin-insensitive types, Lancet, 1936, ccxxx, 127. Google Scholar16. SOSKINALLWEISSCOHN SMDDJ: Influence of the pancreas and the liver upon the dextrose tolerance curve, Am. Jr. Physiol., 1934, cix, 155. CrossrefGoogle Scholar17. ZUNTZLABARRE EJ: Sur l'augmentation de la teneur en insuline du sang veineux pancréatique après l'hyperglycémie provoquée par injection de glucose, Compt.-rend. Soc. d. biol., 1927, xcvi, 421. Sur la sensibilité des centres nerveux supérieurs à l'hyperglycémie provoquée par l'injection de dextrose, Compt.-rend. Soc. d. biol., 1927, xcvi, 1400. Google Scholar18. CANNON WB: Stresses and strains of homeostasis, Am. Jr. Med. Sci., 1935, clxxxix, 1. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania*Presented at the Detroit meeting of the American College of Physicians, March 2, 1936.From the George S. Cox Medical Research Institute, University of Pennsylvania, Philadelphia. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDiseases of the Adrenal Glands**Some of this material has appeared previously in “The Fundamentals of Internal Medicine” by W. B. Yater, New York, D. Appleton-Century Company, Inc., 1938, pp. 451–509.Disturbances of carbohydrate metabolism observed in association with tumors of the adrenal cortex1Disorders of internal gland secretion in childrenThe unknown liver 1 June 1936Volume 9, Issue 12Page: 1619-1627KeywordsCarbohydrate metabolismDiabetes mellitus ePublished: 1 December 2008 Issue Published: 1 June 1936 PDF downloadLoading ...

CHRONIC ADRENAL INSUFFICIENCY PRODUCED BY CAUTERY

Many attempts have been made to produce chronic adrenal insufficiency. A review of the earlier work is given elsewhere (Hartman). Ligation of a part of the blood supply was used with some success in earlier work. Rogoff recently by the use of this method has succeeded in greatly prolonging the survival period after operation. Symptoms of adrenal insufficiency were observed at intervals. More than two years ago we started a series of experiments on cats in which the adrenal medulla was destroyed, in order to note the behavior of such animals over long periods. Certain observations which appear to be significant are here reported. We tried splitting open the ends of both adrenals and then removing the medulla by a sharp scalpel. The adrenals of the two cats thus operated upon were examined at 272 and 321 days, respectively. Both adrenals contained good medullary tissue in each instance.

Experimental Production of Chronic and Sub-acute Adrenal Insufficiency in Dogs and Cats

Chronic adrenal insufficiency, clinically and pathologically comparable with Addison's disease, has not heretofore been successfully produced in experimental animals. This has been attempted by var...

Effect of Extract of Adrenal Cortex upon Thymic Weight and Resistance to Bacterial Intoxication in Chronic Adrenal Insufficiency.

Extirpation of both adrenal glands is rapidly fatal in most laboratory animals. However this operation seems to have little effect for several weeks upon the physical condition of the majority of rats submitted to it. But such apparently healthy survivors manifest at least 2 important differences from normal rats, an increased susceptibility to bacterial intoxication,1 and hypertrophy of the thymus.2 In each instance the variation has been correlated with a functional deficiency of the adrenal cortex rather than of the medulla.It is our purpose to report the effect of an extract of the adrenal cortex upon this chronic type of adrenal insufficiency, using as criteria the resistance of the animals to bacterial intoxication and the size of the thymus.Fifty-eight rats from 5 litters born on the same day were used. These were divided into 3 groups and sampled for the different groups according to the method adopted by Dr. Luce Clausen,3 insuring equal distribution of weight and equal representation of the diff...

Observations on epinephrectomized cats treated with adrenal cortex hormone. Hartman F.A., Griffith F.R. Ir and W.I. Hartman (Am. J. of Physiol. 86, 360, 1928)

The state of chronic adrenal insufficiency was observed in 108 bilaterally epinephrectomized cats with daily injection of an extract from the adrenal cortex. The symptoms were similar to those of acute insufficiency, but in general they tended to develop more gradually.