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Addison's Disease

ADDISON'S DISEASE, a constitutional affection manifesting itself in an exaggeration of the normal pigment of the skin, asthenia, irritability of the gastro-intestinal tract, and weakness and irregularity of the heart's action: these symptoms being due to loss of function of the suprarenal glands. It is important to note, however, that Addison's Disease may occur without pigmentation, and pigmentation without Addison's Disease. The condition was first recognized by Dr Thomas Addison of Guy's Hospital, who in 1855 published an important work on The Constitutional and Local Effects of Diseases of the Suprarenal Capsules. Sir Samuel Wilks worked zealously in obtaining recognition for these observations in England, and Brown-Sequard in France was stimulated by this paper to investigate the physiology of these glands. Dr Trousseau, many years later, first called the condition by Addison's name. Dr Headlam Greenhow worked at the subject for many years and embodied his observations in the Croonian Lectures of 1875. But from this time on no further work was undertaken until the discovery of the treatment of myxoedema by thyroid extract, and the consequent researches into the physiology of the ductless glands. This stimulated renewed interest in the subject, and work was carried on in many countries. But it remained for Schafer and Oliver of University College, London, to demonstrate the internal secretion of the suprarenals, and its importance in normal metabolism, thereby confirming Addison's original view that the disease was due to loss of function of these glands. They demonstrated that these glands contain a very powerful extract which produces toxic effects when administered to animals, and that an active principle "adrenalin" can be separated, which excites contraction of the small blood vessels and thus raises blood pressure. The latest views of this disease thus stand: (1) that it is entirely dependent on suprarenal disease, being the result of a diminution or absence of their internal secretion, or else of a perversion of their secretion; or (2) that it is of nervous origin, being the result of changes in or irritation of the large sympathetic plexuses in the abdomen; or else (3) that it is a combination of glandular inadequacy and sympathetic irritation.

The morbid anatomy shows (1) that in over 80% of the cases the changes in the suprarenals are those due to tuberculosis, usually beginning in the medulla and resulting in more or less caseation; and that this lesion is bilateral and usually secondary to tuberculous disease elsewhere, especially of the spinal column. In the remaining cases (2) simple atrophy has been noted, or (3) chronic interstitial inflammation which would lead to atrophy; and finally (4) an apparently normal condition of the glands, but the neighbouring sympathetic ganglia diseased or involved in a mass of fibrous tissue. Other morbid conditions of the suprarenals do not give rise to the symptoms of Addison's Disease.

The onset of the disease is extremely insidious, a slow but increasing condition of weakness being complained of by the patient. There is a feeble and irregular action of the heart resulting in attacks of syncope which may prove fatal. Blood pressure is extremely low. From time to time there may be severe attacks of nausea, vomiting or diarrhoea. The best known symptom, but one which only occurs after the disease has made considerable progress, is a gradually increasing pigmentation of the skin, ranging from a bronzy yellow to brown or even occasionally black. This pigmentation shows itself (1) over exposed parts, as face and hands; (2) wherever pigment appears normally, as in the axillae and round the nipples; (3) wherever pressure is applied, as round the waist; and (4) occasionally on mucous membranes, as in the mouth.

The patient's temperature is uqually somewhat subnormal. The disease is found in males far more commonly than in females, and among the lower classes more than the upper. But this latter fact is probably due to poor nourishment and bad hygienic conditions rendering the poorer classes more susceptible to tuberculosis.

The diagnosis, certainly in the early stages of the disease, and often in the later, is by no means easy. Pigmentation of the skin occurs in many conditions--as in normal pregnancy, uterine fibroids, abdominal growths, certain cases of heart disease, exophthalmic goitre, etc., and after the prolonged use of certain drugs--as arsenic and silver. But the presence of a low blood pressure with weakness and irritability of the heart and some of the preceding symptoms render the diagnosis fairly certain. The latest researches on the subject tend to indicate a more certain diagnosis in the effect on the blood pressure of administering suprarenal extract, the blood pressure of the normal subject being unaffected thereby, that of the man suffering from suprarenal inadequacy being markedly raised. The disease is treated by promoting the general health in every possible way; by diet; by tonics, especially arsenic and strychnine; by attention to the hygienic conditions; and always by the administration of one of the many preparations of the suprarenal gland extract.

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Note - this article incorporates content from Encyclopaedia Britannica, Eleventh Edition, (1910-1911)

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