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DISEASES OF THE ADRENAL GLANDS: I. ADDISON'S DISEASE

DISEASES OF THE ADRENAL GLANDS: I. ADDISON'S DISEASE Abstract Since one of us (E. J. K.)1 reviewed for this journal the literature dealing with the diseases of the adrenal glands remarkable progress has been made. Crystalline compounds of known chemical structure have been isolated from the adrenal cortex, and one of these subsequently has been synthesized. The pharmacologic properties of many of these substances have been delineated in detail. As a result the treatment of Addison's disease has improved greatly. Better methods for the recognition of Addison's disease have been developed. The ramifications of the physiologic abnormalities of adrenal cortical insufficiency have been explored further. Knowledge of the relation of the adrenal cortex to the constellation of physiologic processes which pertain to sex has been materially advanced, and, in addition, many experimental studies which are concerned with "interglandular relations" have been conducted. Finally, the therapeutic potentialities of adrenal cortical substances for the treatment of disorders which are not References 1. Kepler, E. J.: Diseases of the Adrenal Glands: A Review with Special Reference to the Clinical Aspects , Arch. Int. Med. 56:105-135 ( (July) ) 1935.Crossref 2. Snell, A. M.: The Treatment of Addison's Disease , Proc. Staff Meet., Mayo Clin. 9:57 ( (Jan. 24) ) 1934. 3. Cragg, R. W.: Personal communication to the authors. 4. Wells, H. G.: Addison's Disease with Selective Destruction of the Suprarenal Cortex , Arch. Path. 10:499-523 ( (Oct.) ) 1930. 5. Wells, H. G.: Humphreys, E. M., and Work, E. G.: Significance of the Increased Frequency of Selective Cortical Necrosis of the Adrenal as a Cause of Addison's Disease , J. A. M. A. 109:490-493 ( (Aug. 14) ) 1937.Crossref 6. Talbott, J. H.; Lever, W. F., and Consolazio, W. V.: Metabolic Studies on Patients with Pemphigus in Relation to Effects of Cortical Extract and Sodium Chloride , J. Invest. Dermat. 3:31-68 ( (Feb.) ) 1940.Crossref 7. Loeb, R. F.: Chemical Changes in the Blood in Addison's Disease , Science 76:420-421 ( (Nov. 4) ) 1932.Crossref 8. Loeb, R. F.: Effect of Sodium Chloride in Treatment of a Patient with Addison's Disease , Proc. Soc. Exper. Biol. & Med. 30:808-812 ( (March) ) 1933. 9. Loeb, R. F.; Atchley, D. W.; Benedict, E. M., and Leland, J.: Electrolyte Balance Studies in Adrenalectomized Dogs with Particular Reference to the Excretion of Sodium , J. Exper. Med. 57:775-792 ( (May) ) 1933. 10. Harrop, G. A.; Soffer, L. J.; Ellsworth, R., and Trescher, J. H.: Studies on the Suprarenal Cortex: III. Plasma Electrolytes and Electrolyte Excretion During Suprarenal Insufficiency in the Dog , J. Exper. Med. 58:17-38 ( (July) ) 1933 11. Rubin. M. I., and Krick, E. T.: The Salt and Water Metabolism of Adrenal Insufficiency and Partial Starvation in Rats , J. Clin. Investigation 15:685-695 ( (Nov.) ) 1936. 12. Such a loss might have been anticipated in view of the fact that blood plasma and interstitial fluids contain more sodium than chloride. 13. Harrop, G. A.; Soffer, L. J.; Nicholson, W. M., and Strauss, M.: Studies on the Suprarenal Cortex: IV. The Effect of Sodium Salts in Sustaining the Suprarenalectomized Dog , J. Exper. Med. 61:839-860 ( (June) ) 1935. 14. Allers, W. D.: The Influence of Diet and Mineral Metabolism on Dogs After Suprarenalectomy , Proc. Staff Meet., Mayo Clin. 10:406-409 ( (June 26) ) 1935 15. Loeb and others.8a 16. Swingle, W. W.; Pfiiffner, J. J.; Vars, H. M., and Parkins, W. M.: The Effect of Sodium Chloride Administration upon Adrenalectomized Dogs Not Receiving Extract , Am. J. Physiol. 108:159-167 ( (April) ) 1934. 17. Hastings, A. B., and Compere, E. L.: Effect of Bilateral Suprarenalectomy on Certain Constituents of the Blood of Dogs , Proc. Soc. Exper. Biol. & Med. 28:376-378 ( (Jan.) ) 1931. 18. Harrop, G. A.; Nicholson, W. M., and Strauss, M.: Studies on the Suprarenal Cortex: V. The Influence of the Cortical Hormone upon the Excretion of Water and Electrolytes in the Suprarenalectomized Dog , J. Exper. Med. 64:233-251 ( (Aug.) ) 1936. 19. Harrison, H. E., and Darrow, D. C.: The Distribution of Body Water and Electrolytes in Adrenal Insufficiency , J. Clin. Investigation 17:77-86 ( (Jan.) ) 1938. 20. Allers, W. D.; Nilson, H. W., and Kendall, E. C.: Studies on Adrenalectomized Dogs: The Toxic Action of Potassium , Proc. Staff Meet., Mayo Clin. 11:283-288 ( (April 29) ) 1936. 21. Allers, W. D., and Kendall, E. C.: Maintenance of Adrenalectomized Dogs Without Cortin, Through Control of the Mineral Constituents of the Diet , Am. J. Physiol. 118:87-94 ( (Jan.) ) 1937. 22. Nilson, H. W.: Corticoadrenal Insufficiency: Metabolism Studies on Potassium, Sodium, and Chloride , Am. J. Physiol. 118:620-631 ( (March) ) 1937. 23. Zwemer, R. L., and Truszkowski, R.: The Importance of Corticoadrenal Regulation of Potassium Metabolism , Endocrinology 21:40-49 ( (Jan.) ) 1937. 24. Cleghron, R. A., and McVicar, G. A.: High Potassium Diet and the Survival of Adrenalectomized Rats , Nature, London 138:124 ( (July 18) ) 1936.Crossref 25. Harrison and Darrow.14 26. Harrop and others.10a 27. Swingle and others.11 28. Wilder, R. M.; Kendall, E. C.; Snell, A. M.; Kepler, E. J.; Rynearson, E. H., and Adams, M.: Intake of Potassium, Important Consideration in Addison's Disease , Arch. Int. Med. 59:367-393 ( (March) ) 1937.Crossref 29. Victor, Sister Mary: A Diet Restricted in Potassium , J. Am. Dietet. A. 14:759-772 ( (Dec.) ) 1938. 30. Greene, J. A., and Johnston, G. W.: Electrolyte Balance During Treatment, Crises, and Severe Infection in Cases of Addison's Disease , Arch. Int. Med. 66:1052-1059 ( (Nov.) ) 1940.Crossref 31. Footnote 16 a and b. 32. The observations of Rabinowitch, Nelken and Steinitz and Bolliger and Breh were cited by Harrison and Darrow.14 33. Miller, H. C., and Darrow, D. C.: Relation of Serum and Muscle Electrolyte, Particularly Potassium, to Voluntary Exercise , Am. J. Physiol. 132:801-809 ( (April) ) 1941. 34. Miller, H. C., and Darrow, D. C.: The Effect of Changes in Muscle Electrolyte on the Response of Skeletal Muscle to Tetanic Stimulation with Particular Reference to Potassium , Am. J. Physiol. 129:264-270 ( (May) ) 1940. 35. Fenn, W. O.: The Role of Potassium in Physiologic Processes , Physiol. Rev. 20:377-415 ( (July) ) 1940. 36. Harrison, H. E., and Darrow, D. C.: Renal Function in Experimental Adrenal Insufficiency , Am. J. Physiol. 125:631-643 ( (April) ) 1939. 37. Willson, D. M., and Sunderman, F. W.: Studies in Serum Electrolytes: XII. The Effect of Water Restriction in a Patient with Addison's Disease Receiving Sodium Chloride , J. Clin. Investigation 18:35-43 ( (Jan.) ) 1939.Crossref 38. Willsin, D. M.: Electrolyte Balance Studies in Addison's Disease, Thesis, University of Minnesota Graduate School of Medicine, 1940. 39. Gersh, I., and Grollman, A.: Kidney Function in Adrenal Cortical Insufficiency , Am. J. Physiol. 125:66-74 ( (Jan.) ) 1939. 40. Smith, H. W.: Kidney , in Luck, J. M., and Hall, V. E.: Annual Review of Physiology , Stanford University, Calif., Stanford University Press, 1939, vol. 1, pp. 505-529. 41. Harrop, G. A.; Weinstein, A.; Soffer, L. J., and Trescher. J. H.: Studies on the Suprarenal Cortex: II. Metabolism, Circulation, and Blood Concentration During Suprarenal Insufficiency in the Dog , J. Exper. Med. 58:1-16 ( (July) ) 1933.Crossref 42. Swingle, W. W.; Vars, H. M., and Parkins, W. M.: A Study of the Blood Volume of Adrenalectomized Dogs , Am. J. Physiol. 109:488-501 ( (Sept.) ) 1934. 43. Harrop, G. A.: The Influence of the Adrenal Cortex upon the Distribution of Body Water , Bull. Johns Hopkins Hosp. 59:11-24 ( (July) ) 1936. 44. Gamble, J. L.: Extracellular Fluid and Its Vicissitudes , Bull. Johns Hopkins Hosp. 61:151-173 ( (Sept.) ) 1937. 45. Since more than 90 per cent of extracellular base is sodium, changes in the remaining basic ions have little effect on the concentration of total bases. The acid ions, chloride, bicarbonate and protein, play only a secondary role in the body economy; their total ionic concentration is automatically regulated by respiration and by the kidneys to equal the total concentration of base. For a detailed discussion of this phase of the problem, the reader is referred to the admirable exposition by Gamble.32 46. Hegnauer, A. H., and Robinson, E. J.: The Water and Electrolyte Distribution Among Plasma, Red Blood Cells, and Muscle After Adrenalectomy , J. Biol. Chem. 116:769-778 ( (Dec.) ) 1936. 47. Muntwyler, E.; Mautz, F. R.; Mangun, G., and Mellors, R. C.: Electrolyte and Water Exchanges Between Muscle and Blood in Adrenal Insufficiency , J. Biol. Chem. 128:1xxiv ( (June) ) 1939. 48. Yannet, H., and Darrow, D. C.: The Effect of Depletion of Extracellular Electrolytes on the Chemical Composition of Skeletal Muscle, Liver, and Cardiac Muscle , J. Biol. Chem. 134: 721-737 ( (July) ) 1940. 49. Darrow, D. C., and Yannet, H.: The Changes in the Distribution of Body Water Accompanying Increase and Decrease in Extracellular Electrolyte , J. Clin. Investigation 14:266-275 ( (March) ) 1935.Crossref 50. Ingle, D. J., and Kendall, E. C.: Survival of the Adrenalectomized Nephrectomized Rat , Am. J. Physiol. 117:200-202 ( (Oct.) ) 1936. 51. Ingle, D. J.; Nilson, H. W., and Kendall, E. C.: The Effect of Cortin on the Concentration of Some Constituents of the Blood of Adrenalectomized Rats , Am. J. Physiol. 118:302-308 ( (Feb.) ) 1937. 52. MacKay, E. M.; Bergman, H. C., and MacKay, L. L. L.: Serum Potassium and Sodium as Altered by Adrenalectomy and Nephrectomy , Am. J. Physiol. 120:83-86 ( (Sept.) ) 1937. 53. Hartman, F. A., and Dubach, R.: The Effect of Adrenal Preparations on the Adrenalectomized-Nephrectomized Rat , Endocrinology 27:638-641 ( (Oct.) ) 1940.Crossref 54. Swingle, W. W.; Parkins, W. M.; Taylor, A. R., and Hays, H. W.: The Influence of Adrenal Cortical Hormone upon Electrolyte and Fluid Distribution in Adrenalectomized Dogs Maintained on a Sodium and Chloride Free Diet , Am. J. Physiol. 119:684-691 ( (Aug.) ) 1937. 55. Swingle, W. W.; Parkins, W. M.; Taylor, A. R., and Hays, H. W.: Relation of Serum Sodium and Chloride Levels to Alterations of Body Water in the Intact and Adrenalectomized Dog, and the Influence of Adrenal Cortical Hormone upon Fluid Distribution , Am. J. Physiol. 116:438-445 ( (July) ) 1936. 56. Britton, S. W., and Silvette, H.: The Apparent Prepotent Function of the Adrenal Glands , J. Physiol. 100:701-713 ( (May) ) 1932. 57. Long, C. N. H.; Katzin. B., and Fry, E. G.: The Adrenal Cortex and Carbohydrate Metabolism , Endocrinology 26:309-344 ( (Feb.) ) 1940.Crossref 58. Sprague, R. G.: The Influence of Extract of the Adrenal Cortex on Glyocgenesis in Fasting Rats , Proc. Staff Meet., Mayo Clin. 15:291-294 ( (May 8) ) 1940. 59. Thorn, G. W.; Koepf, G. F.; Lewis, R. A., and Olsen, E. F.: Carbohydrate Metabolism in Addison's Disease , J. Clin. Investigation 19:813-832 ( (Nov.) ) 1940.Crossref 60. Evans, G.: The Adrenal Cortex and Endogenous Carbohydrate Formation , Am. J. Physiol. 114:297-308 ( (Jan.) ) 1936. 61. Lewis, R. A.; Kuhlman, D.; Delbue, C.; Koepf, G. F., and Thorn, G. W.: The Effect of the Adrenal Cortex on Carbohydrate Metabolism , Endocrinology 27:971-982 ( (Dec.) ) 1940.Crossref 62. Wells, B. B.: The Influence of Crystalline Compounds Separated from the Adrenal Cortex on Gluconeogenesis , Proc. Staff Meet., Mayo Clin. 15:294-297 ( (May 8) ) 1940. 63. Long, Katzin and Fry.40 Lewis and others.43b 64. Wells.44 65. Wells, B. B., and Kendall, E. C.: The Influence of the Adrenal Cortex on Phlorhizin Diabetes , Proc. Staff Meet., Mayo Clin. 15:565-573 ( (Sept. 4) ) 1940. 66. Kendall, E. C.: Flock, E. V.; Bollman, J. L., and Mann, F. C.: The Influence of Cortin and Sodium Chloride in Carbohydrate and Mineral Metabolism in Adrenalectomized Dogs , J. Biol. Chem. 126:697-708 ( (Dec.) ) 1938. 67. Lewis and others.43b 68. Britton and Silvette.39 69. Long, Katzin and Fry.40 70. Sprague.41 71. Britton, S. W., and Silvette, H.: On the Function of the Adrenal Cortex— General, Carbohydrate and Circulatory Theories , Am. J. Physiol. 107:190-206 ( (Jan.) ) 1934. 72. Buell, M. V.; Anderson, I. A., and Strauss, M. B.: On Carbohydrate Metabolism in Adrenalectomized Animals , Am. J. Physiol. 116:274-281 ( (July) ) 1936. 73. Anderson, I. A., and Lyall, A.: Addison's Disease Due to Suprarenal Atrophy with Previous Thyrotoxicosis and Death from Hypoglycemia , Lancet 1: 1039-1043 ( (May 1) ) 1937.Crossref 74. Rushton, J. G.; Cragg, R. W., and Stalker, L. K.: Spontaneous Hypoglycemia Due to Atrophy of the Adrenal Glands. Arch. Int. Med. 66:531-540 ( (Sept.) ) 1940.Crossref 75. Soskin, S.: Metabolic Function of the Endocrine Glands , in Luck, J. M., and Hall, V. E.: Annual Review of Physiology , Stanford University, Calif., Stanford University Press, 1941, vol. 3, pp. 543-572. 76. Kendall, E. C.: The Adrenal Cortex , Arch. Path. 32:474-501 ( (Sept.) ) 1941. 77. Loeb, R. F.: Conferences on Therapy: Treatment of Addison's Disease , J. A. M. A. 112:2511-2516 ( (June 17) ) 1939.Crossref 78. Hartman, F. A., and Thorn, G. W.: A Biological Method for the Assay of Cortin , Proc. Soc. Exper. Biol. & Med. 28:94-95 ( (Nov.) ) 1930. 79. Kutz, R. L.: A Method of Assay of Extracts Containing the Suprarenal Cortical Hormone , Proc. Soc. Exper. Biol. & Med. 29:91-93 ( (Oct.) ) 1931. 80. Ingle, D. J.: Work Capacity of the Adrenalectomized Rat Treated with Cortin , Am. J. Physiol. 116:622-625 ( (Aug.) ) 1936. 81. Harrop, G. A.; Pfiffner, J. J.; Weinstein, A., and Swingle, W. W.: A Biological Method of Assay of the Adrenal Cortical Hormone , Proc. Soc. Exper. Biol. & Med. 29:449-451 ( (Jan.) ) 1932. 82. Pfiffner, J. J.; Swingle, W. W., and Vars, H. M.: The Cortical Hormone Requirement of the Adrenalectomized Dog, with Special Reference to a Method of Assay , J. Biol. Chem. 104:701-716 ( (March) ) 1934. 83. Harrop, G. A., and Thorn. G. W.: Studies on the Suprarenal Cortex: VI. The Effect of Suprarenal Cortical Hormone upon the Electrolyte Excretion of the Intact Normal Dog; a Proposed Method of Comparative Assay , J. Exper. Med. 65:757-766 ( (June) ) 1937. 84. Selye, H., and Schenker, V.: A Rapid and Sensitive Method for Bioassay of the Adrenalcortical Hormone , Proc. Soc. Exper. Biol. & Med. 39:518-522 ( (Dec.) ) 1938. 85. Mason, H. L.: Chemistry of the Adrenal Cortical Hormone , Endocrinology 25:405-412 ( (Sept.) ) 1939. 86. Wells, B. B., and Kendall, E. C.: A Qualitative Difference in the Effect of Compounds Separated from the Adrenal Cortex on Distribution of Electrolytes and on Atrophy of the Adrenal and Thymus Glands of Rats , Proc. Staff Meet., Mayo Clin. 15:133-139 ( (Feb. 28) ) 1940. 87. Thorn, G. W., and Eisenberg, H.: Stndies on Desoxy-Corticosterone , Endocrinology 25:39-46 ( (July) ) 1939. 88. Thorn, G. W.; Engel, L. W., and Eisenberg, H.: The Effect of Corticosterone and Related Compounds on the Renal Excretion of Electrolytes , J. Exper. Med. 68:161-172 ( (Aug.) ) 1938. 89. Simpson, S. L.: The Use of Desoxycorticosterone Acetate in Addison's Disease , Lancet 2:557 ( (Sept. 3) ) 1938 90. McCullagh, E. P.: Sodium and Chloride Retention in Addison's Disease Treated with Desoxycorticosterone Acetate , Cleveland Clin. Quart. 6:105-108 ( (April) ) 1939. 91. Dryerre, H. W.: Effect of Desoxycorticosterone Acetate and Cortin on Salt Elimination in Addison's Disease , Brit. M. J. 1:971-973 ( (May 13) ) 1939. 92. Thorn, G. W.; Howard, R. P., and Emerson, K., Jr.: Treatment of Addison's Disease with Desoxy-Corticosterone Acetate, a Synthetic Adrenal Cortical Hormone , J. Clin. Investigation 18:449-467 ( (July) ) 1939. 93. Cleghorn, R. A.; Fowler, J. L. A., and Wenzel, J. S.: The Treatment of Addison's Disease by a Synthetic Adrenal Cortical Hormone (Desoxycorticosterone Acetate) , Canad. M. A. J. 41:226-231 ( (Sept.) ) 1939. 94. Ferrebee, J. W.; Ragan, C.; Atchley, D. W., and Loeb, R. F.: Desoxycorticosterone Esters: Certain Effects in the Treatment of Addison's Disease , J. A. M. A. 113:1725-1731 ( (Nov. 4) ) 1939. 95. Willson, D. M.; Rynearson, E. H., and Dry, T. J.: Cardiac Failure Following Treatment of Addison's Disease with Desoxycorticosterone Acetate , Proc. Staff Meet., Mayo Clin. 16:168-173 ( (March 12) ) 1941. 96. Ferrebee and others.62h 97. Long, Katzin and Fry.40 Wells.44 Lewis and others.43b Thorn and others.42 98. Hampton, H. P.: Personal communication to the authors. 99. Kendall, E. C.: Glandular Physiology and Therapy: The Function of the Adrenal Cortex , J. A. M. A. 116:2394-2398 ( (May 24) ) 1941. 100. Kendall, E. C.: The Function of the Adrenal Cortex , Proc. Staff Meet., Mayo Clin. 15:297-304 ( (May 8) ) 1940 101. Hormones , in Luck, J. M., and Smith, J. H. C.: Annual Review of Biochemistry , Stanford University, Calif., Stanford University Press, 1941, vol. 10, pp. 285-336. 102. Harrop, G. A.; Weinstein, A.; Soffer, L. J., and Trescher, J. H.: The Diagnosis and Treatment of Addison's Disease , J. A. M. A. 100:1850-1855 ( (June 10) ) 1933. 103. Lilienfield, A.: The Use of the Low Salt Diet in the Diagnosis of Addison's Disease , J. A. M. A. 110:804-805 ( (March 12) ) 1938.Crossref 104. Garvin, C. F., and Reichle, H. S.: Death Presumably Due to the Use of the Salt Restriction Test in the Diagnosis of Addison's Disease , Ann. Int. Med. 14:323-324 ( (Aug.) ) 1940.Crossref 105. Cutler, H. H.; Power, M. H., and Wilder, R. M.: Concentrations of Sodium, Chloride, and Potassium in the Blood Plasma and Urine of Patients with Addison's Disease: Their Diagnostic Significance , Proc. Staff Meet., Mayo Clin. 13:244-249 ( (April 20) ) 1938 106. Concentrations of Chloride, Sodium, and Potassium in Urine and Blood: Their Diagnostic Significance in Adrenal Insufficiency , J. A. M. A. 111:117-122 ( (July 9) ) 1938. 107. McCullagh, E. P., and Ryan, E. J.: The Use of Desoxycorticosterone Acetate in Addison's Disease , J. A. M. A. 114:2530-2537 ( (June 29) ) 1940.Crossref 108. Dryerre, H. W.: Addison's Disease: The Diagnostic Significance of the Sodium and Chloride Content of the Blood and Urine , Edinburgh M. J. 46:267-277 ( (April) ) 1939. 109. Thorn, G. W., and Firor, W. M.: Desoxycorticosterone Acetate Therapy in Addison's Disease: Clinical Considerations , J. A. M. A. 114:2517-2525 ( (June 29) ) 1940.Crossref 110. Stephens, D. J.: Pituitary and Adrenocortical Insufficiency: The Use of Sodium Chloride in the Treatment of Hypopituitarism , J. Clin. Endocrinol. 1:109-112 ( (Feb.) ) 1941.Crossref 111. Thorn, G. W.; Howard, R. P., and Dayman, H.: Electrolyte Changes in Pulmonary Tuberculosis, with Special Reference to Adrenal Cortical Function , Bull. Johns Hopkins Hosp. 67:345-364 ( (Nov.) ) 1940. 112. Willson, D. M.; Robinson, F. J.; Power, M. H., and Wilder, R. M.: The Diagnosis of Adrenal Cortical Insufficiency: Further Experience with the Cutler-Power-Wilder Salt Restriction Test , Arch. Int. Med. , to be published. 113. Robinson, F. J.; Power, M. H., and Kepler, E. J.: Two New Procedures to Assist in the Recognition and Exclusion of Addison's Disease: A Preliminary Report , Proc. Staff Meet., Mayo Clin. 16:577-583 ( (Sept. 10) ) 1941. 114. The term "day urine" applies to the largest of the hourly specimens voided during the day and "night urine," to the entire amount which was voided from 10:30 p. m. to 7:30 a. m. It is immaterial how these values are expressed, provided the same unit is used throughout the equation. For example, if the concentration of chloride in the plasma is expressed as milligrams of chloride per hundred cubic centimeters of plasma, the concentration of chloride in the urine should be expressed in the same manner. 115. Thorn, G. W.; Garbutt, H. R.; Hitchcock, F. A., and Hartman, F. A.: The Effect of Cortin on the Sodium, Potassium, Chloride, Inorganic Phosphorus, and Total Nitrogen Balance in Normal Subjects and in Patients with Addison's Disease , Endocrinology 21:202-212 ( (March) ) 1937.Crossref 116. Zwemer, R. L., and Truszkowski, R.: Factors Affecting Human Potassium Tolerance , Proc. Soc. Exper. Biol. & Med. 35:424-426 ( (Dec.) ) 1936. 117. Greene, J. A.; Levine, H., and Johnston, G. W.: Is the Potassium Tolerance Curve of Value in the Diagnosis of Adrenal Cortical Insufficiency in Man? Endocrinology 27:375-377 ( (Sept.) ) 1940. 118. Footnotes 10a and b. 119. Hampton, H. P., and Kepler, E. J.: Addison's Disease: Treatment and Prognosis , Am. J. M. Sc. 202:264-271 ( (Aug.) ) 1941. 120. Thompson, W. O.; Thompson, P. K.; Taylor, S. G., III, and Hoffman, W. S.: The Treatment of Addison's Disease with Adrenal Cortex Extract , Endocrinology 24:774-797 ( (June) ) 1939. 121. Thompson, W. O.: Therapeutic Symposium: Discussion , J. Clin. Endocrinol. 1:83-84 ( (Jan.) ) 1941. 122. Wilder, R. M.: Progress in Treatment of Addison's Disease , Proc. Staff Meet., Mayo Clin. 15:273-277 ( (May 1) ) 1940. 123. Thorn, G. W.: Adrenal Cortical Hormone Therapy , Am. J. M. Sc. 197:718-729 ( (May) ) 1939. 124. Footnote 62 c, d, e and f. 125. Ferrebee and others.62h Willson, Rynearson and Dry.63a Wilder.82 Thorn.83a 126. Sudden death frequently occurred in cases of Addison's disease prior to the introduction of any form of replacement therapy. There is a strong temptation to attribute these deaths to hypoglycemia. The available evidence, however, does not warrant this assumption. 127. Gordon, E. S.: The Use of Desoxycorticosterone and Its Esters in the Treatment of Addison's Disease , J. A. M. A. 114:2549-2551 ( (June 29) ) 1940. 128. Kendall.66 Thompson.81 129. Kuhlmann, D.; Ragan, C.; Ferrebee, J. W.; Atchley, D. W., and Loeb, R. F.: Toxic Effect of Desoxycorticosterone Esters in Dogs , Science 90:496-497 ( (Nov. 24) ) 1939. 130. Ferrebee and others.62h 131. Tooke, T. B., Jr.; Power, M. H., and Kepler, E. J.: The Tolerance of Patients Suffering from Addison's Disease to Potassium While Such Patients Are Being Treated with Desoxycorticosterone Acetate , Proc. Staff Meet., Mayo Clin. 15:365-368 ( (May 1) ) 1940. 132. Roth, G. M.; Robinson, F. J., and Wilder, R. M.: Response of the Blood Pressure to the Cold Pressor Test in Addison's Disease During Treatment with Desoxycorticosterone Acetate , J. A. M. A. 116:2429-2430 [ (May 24) ] 1941 133. Thorn, G. W.: Treatment of Addison's Disease , J. Clin. Endocrinol. 1:76-81 ( (Jan.) ) 1941.Crossref 134. Thorn, G. W.; Howard, R. P.; Emerson, K., Jr., and Firor, W. M.: Treatment of Addison's Disease with Pellets of Crystalline Adrenal Cortical Hormone (Synthetic Desoxy-Corticocosterone Acetate): Implanted Subcutaneously , Bull. Johns Hopkins Hosp. 64:339-365 ( (May) ) 1939. 135. Anderson, E.; Haymaker, W., and Henderson, E.: Successful Sublingual Therapy in Addison's Disease , J. A. M. A. 115:2167-2168 ( (Dec. 21) ) 1940.Crossref 136. Turnoff, D., and Rowntree, L. G.: Successful Sublingual Therapy in Addison's Disease , J. A. M. A. 116:2016 ( (May 3) ) 1941.Crossref 137. Hampton, H. P., and Kepler, E. J.: Addison's Disease: Treatment and Prognosis , Am. J. M. Sc. 202:264-271 ( (Aug.) ) 1941.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

DISEASES OF THE ADRENAL GLANDS: I. ADDISON'S DISEASE

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Publisher
American Medical Association
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Copyright © 1941 American Medical Association. All Rights Reserved.
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0730-188X
DOI
10.1001/archinte.1941.00200110131008
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Abstract

Abstract Since one of us (E. J. K.)1 reviewed for this journal the literature dealing with the diseases of the adrenal glands remarkable progress has been made. Crystalline compounds of known chemical structure have been isolated from the adrenal cortex, and one of these subsequently has been synthesized. The pharmacologic properties of many of these substances have been delineated in detail. As a result the treatment of Addison's disease has improved greatly. Better methods for the recognition of Addison's disease have been developed. The ramifications of the physiologic abnormalities of adrenal cortical insufficiency have been explored further. Knowledge of the relation of the adrenal cortex to the constellation of physiologic processes which pertain to sex has been materially advanced, and, in addition, many experimental studies which are concerned with "interglandular relations" have been conducted. Finally, the therapeutic potentialities of adrenal cortical substances for the treatment of disorders which are not References 1. Kepler, E. J.: Diseases of the Adrenal Glands: A Review with Special Reference to the Clinical Aspects , Arch. Int. Med. 56:105-135 ( (July) ) 1935.Crossref 2. Snell, A. M.: The Treatment of Addison's Disease , Proc. Staff Meet., Mayo Clin. 9:57 ( (Jan. 24) ) 1934. 3. Cragg, R. W.: Personal communication to the authors. 4. Wells, H. G.: Addison's Disease with Selective Destruction of the Suprarenal Cortex , Arch. Path. 10:499-523 ( (Oct.) ) 1930. 5. Wells, H. G.: Humphreys, E. M., and Work, E. G.: Significance of the Increased Frequency of Selective Cortical Necrosis of the Adrenal as a Cause of Addison's Disease , J. A. M. A. 109:490-493 ( (Aug. 14) ) 1937.Crossref 6. Talbott, J. H.; Lever, W. F., and Consolazio, W. V.: Metabolic Studies on Patients with Pemphigus in Relation to Effects of Cortical Extract and Sodium Chloride , J. Invest. Dermat. 3:31-68 ( (Feb.) ) 1940.Crossref 7. Loeb, R. F.: Chemical Changes in the Blood in Addison's Disease , Science 76:420-421 ( (Nov. 4) ) 1932.Crossref 8. Loeb, R. F.: Effect of Sodium Chloride in Treatment of a Patient with Addison's Disease , Proc. Soc. Exper. Biol. & Med. 30:808-812 ( (March) ) 1933. 9. Loeb, R. F.; Atchley, D. W.; Benedict, E. M., and Leland, J.: Electrolyte Balance Studies in Adrenalectomized Dogs with Particular Reference to the Excretion of Sodium , J. Exper. Med. 57:775-792 ( (May) ) 1933. 10. Harrop, G. A.; Soffer, L. J.; Ellsworth, R., and Trescher, J. H.: Studies on the Suprarenal Cortex: III. Plasma Electrolytes and Electrolyte Excretion During Suprarenal Insufficiency in the Dog , J. Exper. Med. 58:17-38 ( (July) ) 1933 11. Rubin. M. I., and Krick, E. T.: The Salt and Water Metabolism of Adrenal Insufficiency and Partial Starvation in Rats , J. Clin. Investigation 15:685-695 ( (Nov.) ) 1936. 12. Such a loss might have been anticipated in view of the fact that blood plasma and interstitial fluids contain more sodium than chloride. 13. Harrop, G. A.; Soffer, L. J.; Nicholson, W. M., and Strauss, M.: Studies on the Suprarenal Cortex: IV. The Effect of Sodium Salts in Sustaining the Suprarenalectomized Dog , J. Exper. Med. 61:839-860 ( (June) ) 1935. 14. Allers, W. D.: The Influence of Diet and Mineral Metabolism on Dogs After Suprarenalectomy , Proc. Staff Meet., Mayo Clin. 10:406-409 ( (June 26) ) 1935 15. Loeb and others.8a 16. Swingle, W. W.; Pfiiffner, J. J.; Vars, H. M., and Parkins, W. M.: The Effect of Sodium Chloride Administration upon Adrenalectomized Dogs Not Receiving Extract , Am. J. Physiol. 108:159-167 ( (April) ) 1934. 17. Hastings, A. B., and Compere, E. L.: Effect of Bilateral Suprarenalectomy on Certain Constituents of the Blood of Dogs , Proc. Soc. Exper. Biol. & Med. 28:376-378 ( (Jan.) ) 1931. 18. Harrop, G. A.; Nicholson, W. M., and Strauss, M.: Studies on the Suprarenal Cortex: V. The Influence of the Cortical Hormone upon the Excretion of Water and Electrolytes in the Suprarenalectomized Dog , J. Exper. Med. 64:233-251 ( (Aug.) ) 1936. 19. Harrison, H. E., and Darrow, D. C.: The Distribution of Body Water and Electrolytes in Adrenal Insufficiency , J. Clin. Investigation 17:77-86 ( (Jan.) ) 1938. 20. Allers, W. D.; Nilson, H. W., and Kendall, E. C.: Studies on Adrenalectomized Dogs: The Toxic Action of Potassium , Proc. Staff Meet., Mayo Clin. 11:283-288 ( (April 29) ) 1936. 21. Allers, W. D., and Kendall, E. C.: Maintenance of Adrenalectomized Dogs Without Cortin, Through Control of the Mineral Constituents of the Diet , Am. J. Physiol. 118:87-94 ( (Jan.) ) 1937. 22. Nilson, H. W.: Corticoadrenal Insufficiency: Metabolism Studies on Potassium, Sodium, and Chloride , Am. J. Physiol. 118:620-631 ( (March) ) 1937. 23. Zwemer, R. L., and Truszkowski, R.: The Importance of Corticoadrenal Regulation of Potassium Metabolism , Endocrinology 21:40-49 ( (Jan.) ) 1937. 24. Cleghron, R. A., and McVicar, G. A.: High Potassium Diet and the Survival of Adrenalectomized Rats , Nature, London 138:124 ( (July 18) ) 1936.Crossref 25. Harrison and Darrow.14 26. Harrop and others.10a 27. Swingle and others.11 28. Wilder, R. M.; Kendall, E. C.; Snell, A. M.; Kepler, E. J.; Rynearson, E. H., and Adams, M.: Intake of Potassium, Important Consideration in Addison's Disease , Arch. Int. Med. 59:367-393 ( (March) ) 1937.Crossref 29. Victor, Sister Mary: A Diet Restricted in Potassium , J. Am. Dietet. A. 14:759-772 ( (Dec.) ) 1938. 30. Greene, J. A., and Johnston, G. W.: Electrolyte Balance During Treatment, Crises, and Severe Infection in Cases of Addison's Disease , Arch. Int. Med. 66:1052-1059 ( (Nov.) ) 1940.Crossref 31. Footnote 16 a and b. 32. The observations of Rabinowitch, Nelken and Steinitz and Bolliger and Breh were cited by Harrison and Darrow.14 33. Miller, H. C., and Darrow, D. C.: Relation of Serum and Muscle Electrolyte, Particularly Potassium, to Voluntary Exercise , Am. J. Physiol. 132:801-809 ( (April) ) 1941. 34. Miller, H. C., and Darrow, D. C.: The Effect of Changes in Muscle Electrolyte on the Response of Skeletal Muscle to Tetanic Stimulation with Particular Reference to Potassium , Am. J. Physiol. 129:264-270 ( (May) ) 1940. 35. Fenn, W. O.: The Role of Potassium in Physiologic Processes , Physiol. Rev. 20:377-415 ( (July) ) 1940. 36. Harrison, H. E., and Darrow, D. C.: Renal Function in Experimental Adrenal Insufficiency , Am. J. Physiol. 125:631-643 ( (April) ) 1939. 37. Willson, D. M., and Sunderman, F. W.: Studies in Serum Electrolytes: XII. The Effect of Water Restriction in a Patient with Addison's Disease Receiving Sodium Chloride , J. Clin. Investigation 18:35-43 ( (Jan.) ) 1939.Crossref 38. Willsin, D. M.: Electrolyte Balance Studies in Addison's Disease, Thesis, University of Minnesota Graduate School of Medicine, 1940. 39. Gersh, I., and Grollman, A.: Kidney Function in Adrenal Cortical Insufficiency , Am. J. Physiol. 125:66-74 ( (Jan.) ) 1939. 40. Smith, H. W.: Kidney , in Luck, J. M., and Hall, V. E.: Annual Review of Physiology , Stanford University, Calif., Stanford University Press, 1939, vol. 1, pp. 505-529. 41. Harrop, G. A.; Weinstein, A.; Soffer, L. J., and Trescher. J. H.: Studies on the Suprarenal Cortex: II. Metabolism, Circulation, and Blood Concentration During Suprarenal Insufficiency in the Dog , J. Exper. Med. 58:1-16 ( (July) ) 1933.Crossref 42. Swingle, W. W.; Vars, H. M., and Parkins, W. M.: A Study of the Blood Volume of Adrenalectomized Dogs , Am. J. Physiol. 109:488-501 ( (Sept.) ) 1934. 43. Harrop, G. A.: The Influence of the Adrenal Cortex upon the Distribution of Body Water , Bull. Johns Hopkins Hosp. 59:11-24 ( (July) ) 1936. 44. Gamble, J. L.: Extracellular Fluid and Its Vicissitudes , Bull. Johns Hopkins Hosp. 61:151-173 ( (Sept.) ) 1937. 45. Since more than 90 per cent of extracellular base is sodium, changes in the remaining basic ions have little effect on the concentration of total bases. The acid ions, chloride, bicarbonate and protein, play only a secondary role in the body economy; their total ionic concentration is automatically regulated by respiration and by the kidneys to equal the total concentration of base. For a detailed discussion of this phase of the problem, the reader is referred to the admirable exposition by Gamble.32 46. Hegnauer, A. H., and Robinson, E. J.: The Water and Electrolyte Distribution Among Plasma, Red Blood Cells, and Muscle After Adrenalectomy , J. Biol. Chem. 116:769-778 ( (Dec.) ) 1936. 47. Muntwyler, E.; Mautz, F. R.; Mangun, G., and Mellors, R. C.: Electrolyte and Water Exchanges Between Muscle and Blood in Adrenal Insufficiency , J. Biol. Chem. 128:1xxiv ( (June) ) 1939. 48. Yannet, H., and Darrow, D. C.: The Effect of Depletion of Extracellular Electrolytes on the Chemical Composition of Skeletal Muscle, Liver, and Cardiac Muscle , J. Biol. Chem. 134: 721-737 ( (July) ) 1940. 49. Darrow, D. C., and Yannet, H.: The Changes in the Distribution of Body Water Accompanying Increase and Decrease in Extracellular Electrolyte , J. Clin. Investigation 14:266-275 ( (March) ) 1935.Crossref 50. Ingle, D. J., and Kendall, E. C.: Survival of the Adrenalectomized Nephrectomized Rat , Am. J. Physiol. 117:200-202 ( (Oct.) ) 1936. 51. Ingle, D. J.; Nilson, H. W., and Kendall, E. C.: The Effect of Cortin on the Concentration of Some Constituents of the Blood of Adrenalectomized Rats , Am. J. Physiol. 118:302-308 ( (Feb.) ) 1937. 52. MacKay, E. M.; Bergman, H. C., and MacKay, L. L. L.: Serum Potassium and Sodium as Altered by Adrenalectomy and Nephrectomy , Am. J. Physiol. 120:83-86 ( (Sept.) ) 1937. 53. Hartman, F. A., and Dubach, R.: The Effect of Adrenal Preparations on the Adrenalectomized-Nephrectomized Rat , Endocrinology 27:638-641 ( (Oct.) ) 1940.Crossref 54. Swingle, W. W.; Parkins, W. M.; Taylor, A. R., and Hays, H. W.: The Influence of Adrenal Cortical Hormone upon Electrolyte and Fluid Distribution in Adrenalectomized Dogs Maintained on a Sodium and Chloride Free Diet , Am. J. Physiol. 119:684-691 ( (Aug.) ) 1937. 55. Swingle, W. W.; Parkins, W. M.; Taylor, A. R., and Hays, H. W.: Relation of Serum Sodium and Chloride Levels to Alterations of Body Water in the Intact and Adrenalectomized Dog, and the Influence of Adrenal Cortical Hormone upon Fluid Distribution , Am. J. Physiol. 116:438-445 ( (July) ) 1936. 56. Britton, S. W., and Silvette, H.: The Apparent Prepotent Function of the Adrenal Glands , J. Physiol. 100:701-713 ( (May) ) 1932. 57. Long, C. N. H.; Katzin. B., and Fry, E. G.: The Adrenal Cortex and Carbohydrate Metabolism , Endocrinology 26:309-344 ( (Feb.) ) 1940.Crossref 58. Sprague, R. G.: The Influence of Extract of the Adrenal Cortex on Glyocgenesis in Fasting Rats , Proc. Staff Meet., Mayo Clin. 15:291-294 ( (May 8) ) 1940. 59. Thorn, G. W.; Koepf, G. F.; Lewis, R. A., and Olsen, E. F.: Carbohydrate Metabolism in Addison's Disease , J. Clin. Investigation 19:813-832 ( (Nov.) ) 1940.Crossref 60. Evans, G.: The Adrenal Cortex and Endogenous Carbohydrate Formation , Am. J. Physiol. 114:297-308 ( (Jan.) ) 1936. 61. Lewis, R. A.; Kuhlman, D.; Delbue, C.; Koepf, G. F., and Thorn, G. W.: The Effect of the Adrenal Cortex on Carbohydrate Metabolism , Endocrinology 27:971-982 ( (Dec.) ) 1940.Crossref 62. Wells, B. B.: The Influence of Crystalline Compounds Separated from the Adrenal Cortex on Gluconeogenesis , Proc. Staff Meet., Mayo Clin. 15:294-297 ( (May 8) ) 1940. 63. Long, Katzin and Fry.40 Lewis and others.43b 64. Wells.44 65. Wells, B. B., and Kendall, E. C.: The Influence of the Adrenal Cortex on Phlorhizin Diabetes , Proc. Staff Meet., Mayo Clin. 15:565-573 ( (Sept. 4) ) 1940. 66. Kendall, E. C.: Flock, E. V.; Bollman, J. L., and Mann, F. C.: The Influence of Cortin and Sodium Chloride in Carbohydrate and Mineral Metabolism in Adrenalectomized Dogs , J. Biol. Chem. 126:697-708 ( (Dec.) ) 1938. 67. Lewis and others.43b 68. Britton and Silvette.39 69. Long, Katzin and Fry.40 70. Sprague.41 71. Britton, S. W., and Silvette, H.: On the Function of the Adrenal Cortex— General, Carbohydrate and Circulatory Theories , Am. J. Physiol. 107:190-206 ( (Jan.) ) 1934. 72. Buell, M. V.; Anderson, I. A., and Strauss, M. B.: On Carbohydrate Metabolism in Adrenalectomized Animals , Am. J. Physiol. 116:274-281 ( (July) ) 1936. 73. Anderson, I. A., and Lyall, A.: Addison's Disease Due to Suprarenal Atrophy with Previous Thyrotoxicosis and Death from Hypoglycemia , Lancet 1: 1039-1043 ( (May 1) ) 1937.Crossref 74. Rushton, J. G.; Cragg, R. W., and Stalker, L. K.: Spontaneous Hypoglycemia Due to Atrophy of the Adrenal Glands. Arch. Int. Med. 66:531-540 ( (Sept.) ) 1940.Crossref 75. Soskin, S.: Metabolic Function of the Endocrine Glands , in Luck, J. M., and Hall, V. E.: Annual Review of Physiology , Stanford University, Calif., Stanford University Press, 1941, vol. 3, pp. 543-572. 76. Kendall, E. C.: The Adrenal Cortex , Arch. Path. 32:474-501 ( (Sept.) ) 1941. 77. Loeb, R. F.: Conferences on Therapy: Treatment of Addison's Disease , J. A. M. A. 112:2511-2516 ( (June 17) ) 1939.Crossref 78. Hartman, F. A., and Thorn, G. W.: A Biological Method for the Assay of Cortin , Proc. Soc. Exper. Biol. & Med. 28:94-95 ( (Nov.) ) 1930. 79. Kutz, R. L.: A Method of Assay of Extracts Containing the Suprarenal Cortical Hormone , Proc. Soc. Exper. Biol. & Med. 29:91-93 ( (Oct.) ) 1931. 80. Ingle, D. J.: Work Capacity of the Adrenalectomized Rat Treated with Cortin , Am. J. Physiol. 116:622-625 ( (Aug.) ) 1936. 81. Harrop, G. A.; Pfiffner, J. J.; Weinstein, A., and Swingle, W. W.: A Biological Method of Assay of the Adrenal Cortical Hormone , Proc. Soc. Exper. Biol. & Med. 29:449-451 ( (Jan.) ) 1932. 82. Pfiffner, J. J.; Swingle, W. W., and Vars, H. M.: The Cortical Hormone Requirement of the Adrenalectomized Dog, with Special Reference to a Method of Assay , J. Biol. Chem. 104:701-716 ( (March) ) 1934. 83. Harrop, G. A., and Thorn. G. W.: Studies on the Suprarenal Cortex: VI. The Effect of Suprarenal Cortical Hormone upon the Electrolyte Excretion of the Intact Normal Dog; a Proposed Method of Comparative Assay , J. Exper. Med. 65:757-766 ( (June) ) 1937. 84. Selye, H., and Schenker, V.: A Rapid and Sensitive Method for Bioassay of the Adrenalcortical Hormone , Proc. Soc. Exper. Biol. & Med. 39:518-522 ( (Dec.) ) 1938. 85. Mason, H. L.: Chemistry of the Adrenal Cortical Hormone , Endocrinology 25:405-412 ( (Sept.) ) 1939. 86. Wells, B. B., and Kendall, E. C.: A Qualitative Difference in the Effect of Compounds Separated from the Adrenal Cortex on Distribution of Electrolytes and on Atrophy of the Adrenal and Thymus Glands of Rats , Proc. Staff Meet., Mayo Clin. 15:133-139 ( (Feb. 28) ) 1940. 87. Thorn, G. W., and Eisenberg, H.: Stndies on Desoxy-Corticosterone , Endocrinology 25:39-46 ( (July) ) 1939. 88. Thorn, G. W.; Engel, L. W., and Eisenberg, H.: The Effect of Corticosterone and Related Compounds on the Renal Excretion of Electrolytes , J. Exper. Med. 68:161-172 ( (Aug.) ) 1938. 89. Simpson, S. L.: The Use of Desoxycorticosterone Acetate in Addison's Disease , Lancet 2:557 ( (Sept. 3) ) 1938 90. McCullagh, E. P.: Sodium and Chloride Retention in Addison's Disease Treated with Desoxycorticosterone Acetate , Cleveland Clin. Quart. 6:105-108 ( (April) ) 1939. 91. Dryerre, H. W.: Effect of Desoxycorticosterone Acetate and Cortin on Salt Elimination in Addison's Disease , Brit. M. J. 1:971-973 ( (May 13) ) 1939. 92. Thorn, G. W.; Howard, R. P., and Emerson, K., Jr.: Treatment of Addison's Disease with Desoxy-Corticosterone Acetate, a Synthetic Adrenal Cortical Hormone , J. Clin. Investigation 18:449-467 ( (July) ) 1939. 93. Cleghorn, R. A.; Fowler, J. L. A., and Wenzel, J. S.: The Treatment of Addison's Disease by a Synthetic Adrenal Cortical Hormone (Desoxycorticosterone Acetate) , Canad. M. A. J. 41:226-231 ( (Sept.) ) 1939. 94. Ferrebee, J. W.; Ragan, C.; Atchley, D. W., and Loeb, R. F.: Desoxycorticosterone Esters: Certain Effects in the Treatment of Addison's Disease , J. A. M. A. 113:1725-1731 ( (Nov. 4) ) 1939. 95. Willson, D. M.; Rynearson, E. H., and Dry, T. J.: Cardiac Failure Following Treatment of Addison's Disease with Desoxycorticosterone Acetate , Proc. Staff Meet., Mayo Clin. 16:168-173 ( (March 12) ) 1941. 96. Ferrebee and others.62h 97. Long, Katzin and Fry.40 Wells.44 Lewis and others.43b Thorn and others.42 98. Hampton, H. P.: Personal communication to the authors. 99. Kendall, E. C.: Glandular Physiology and Therapy: The Function of the Adrenal Cortex , J. A. M. A. 116:2394-2398 ( (May 24) ) 1941. 100. Kendall, E. C.: The Function of the Adrenal Cortex , Proc. Staff Meet., Mayo Clin. 15:297-304 ( (May 8) ) 1940 101. Hormones , in Luck, J. M., and Smith, J. H. C.: Annual Review of Biochemistry , Stanford University, Calif., Stanford University Press, 1941, vol. 10, pp. 285-336. 102. Harrop, G. A.; Weinstein, A.; Soffer, L. J., and Trescher, J. H.: The Diagnosis and Treatment of Addison's Disease , J. A. M. A. 100:1850-1855 ( (June 10) ) 1933. 103. Lilienfield, A.: The Use of the Low Salt Diet in the Diagnosis of Addison's Disease , J. A. M. A. 110:804-805 ( (March 12) ) 1938.Crossref 104. Garvin, C. F., and Reichle, H. S.: Death Presumably Due to the Use of the Salt Restriction Test in the Diagnosis of Addison's Disease , Ann. Int. Med. 14:323-324 ( (Aug.) ) 1940.Crossref 105. Cutler, H. H.; Power, M. H., and Wilder, R. M.: Concentrations of Sodium, Chloride, and Potassium in the Blood Plasma and Urine of Patients with Addison's Disease: Their Diagnostic Significance , Proc. Staff Meet., Mayo Clin. 13:244-249 ( (April 20) ) 1938 106. Concentrations of Chloride, Sodium, and Potassium in Urine and Blood: Their Diagnostic Significance in Adrenal Insufficiency , J. A. M. A. 111:117-122 ( (July 9) ) 1938. 107. McCullagh, E. P., and Ryan, E. J.: The Use of Desoxycorticosterone Acetate in Addison's Disease , J. A. M. A. 114:2530-2537 ( (June 29) ) 1940.Crossref 108. Dryerre, H. W.: Addison's Disease: The Diagnostic Significance of the Sodium and Chloride Content of the Blood and Urine , Edinburgh M. J. 46:267-277 ( (April) ) 1939. 109. Thorn, G. W., and Firor, W. M.: Desoxycorticosterone Acetate Therapy in Addison's Disease: Clinical Considerations , J. A. M. A. 114:2517-2525 ( (June 29) ) 1940.Crossref 110. Stephens, D. J.: Pituitary and Adrenocortical Insufficiency: The Use of Sodium Chloride in the Treatment of Hypopituitarism , J. Clin. Endocrinol. 1:109-112 ( (Feb.) ) 1941.Crossref 111. Thorn, G. W.; Howard, R. P., and Dayman, H.: Electrolyte Changes in Pulmonary Tuberculosis, with Special Reference to Adrenal Cortical Function , Bull. Johns Hopkins Hosp. 67:345-364 ( (Nov.) ) 1940. 112. Willson, D. M.; Robinson, F. J.; Power, M. H., and Wilder, R. M.: The Diagnosis of Adrenal Cortical Insufficiency: Further Experience with the Cutler-Power-Wilder Salt Restriction Test , Arch. Int. Med. , to be published. 113. Robinson, F. J.; Power, M. H., and Kepler, E. J.: Two New Procedures to Assist in the Recognition and Exclusion of Addison's Disease: A Preliminary Report , Proc. Staff Meet., Mayo Clin. 16:577-583 ( (Sept. 10) ) 1941. 114. The term "day urine" applies to the largest of the hourly specimens voided during the day and "night urine," to the entire amount which was voided from 10:30 p. m. to 7:30 a. m. It is immaterial how these values are expressed, provided the same unit is used throughout the equation. For example, if the concentration of chloride in the plasma is expressed as milligrams of chloride per hundred cubic centimeters of plasma, the concentration of chloride in the urine should be expressed in the same manner. 115. Thorn, G. W.; Garbutt, H. R.; Hitchcock, F. A., and Hartman, F. A.: The Effect of Cortin on the Sodium, Potassium, Chloride, Inorganic Phosphorus, and Total Nitrogen Balance in Normal Subjects and in Patients with Addison's Disease , Endocrinology 21:202-212 ( (March) ) 1937.Crossref 116. Zwemer, R. L., and Truszkowski, R.: Factors Affecting Human Potassium Tolerance , Proc. Soc. Exper. Biol. & Med. 35:424-426 ( (Dec.) ) 1936. 117. Greene, J. A.; Levine, H., and Johnston, G. W.: Is the Potassium Tolerance Curve of Value in the Diagnosis of Adrenal Cortical Insufficiency in Man? Endocrinology 27:375-377 ( (Sept.) ) 1940. 118. Footnotes 10a and b. 119. Hampton, H. P., and Kepler, E. J.: Addison's Disease: Treatment and Prognosis , Am. J. M. Sc. 202:264-271 ( (Aug.) ) 1941. 120. Thompson, W. O.; Thompson, P. K.; Taylor, S. G., III, and Hoffman, W. S.: The Treatment of Addison's Disease with Adrenal Cortex Extract , Endocrinology 24:774-797 ( (June) ) 1939. 121. Thompson, W. O.: Therapeutic Symposium: Discussion , J. Clin. Endocrinol. 1:83-84 ( (Jan.) ) 1941. 122. Wilder, R. M.: Progress in Treatment of Addison's Disease , Proc. Staff Meet., Mayo Clin. 15:273-277 ( (May 1) ) 1940. 123. Thorn, G. W.: Adrenal Cortical Hormone Therapy , Am. J. M. Sc. 197:718-729 ( (May) ) 1939. 124. Footnote 62 c, d, e and f. 125. Ferrebee and others.62h Willson, Rynearson and Dry.63a Wilder.82 Thorn.83a 126. Sudden death frequently occurred in cases of Addison's disease prior to the introduction of any form of replacement therapy. There is a strong temptation to attribute these deaths to hypoglycemia. The available evidence, however, does not warrant this assumption. 127. Gordon, E. S.: The Use of Desoxycorticosterone and Its Esters in the Treatment of Addison's Disease , J. A. M. A. 114:2549-2551 ( (June 29) ) 1940. 128. Kendall.66 Thompson.81 129. Kuhlmann, D.; Ragan, C.; Ferrebee, J. W.; Atchley, D. W., and Loeb, R. F.: Toxic Effect of Desoxycorticosterone Esters in Dogs , Science 90:496-497 ( (Nov. 24) ) 1939. 130. Ferrebee and others.62h 131. Tooke, T. B., Jr.; Power, M. H., and Kepler, E. J.: The Tolerance of Patients Suffering from Addison's Disease to Potassium While Such Patients Are Being Treated with Desoxycorticosterone Acetate , Proc. Staff Meet., Mayo Clin. 15:365-368 ( (May 1) ) 1940. 132. Roth, G. M.; Robinson, F. J., and Wilder, R. M.: Response of the Blood Pressure to the Cold Pressor Test in Addison's Disease During Treatment with Desoxycorticosterone Acetate , J. A. M. A. 116:2429-2430 [ (May 24) ] 1941 133. Thorn, G. W.: Treatment of Addison's Disease , J. Clin. Endocrinol. 1:76-81 ( (Jan.) ) 1941.Crossref 134. Thorn, G. W.; Howard, R. P.; Emerson, K., Jr., and Firor, W. M.: Treatment of Addison's Disease with Pellets of Crystalline Adrenal Cortical Hormone (Synthetic Desoxy-Corticocosterone Acetate): Implanted Subcutaneously , Bull. Johns Hopkins Hosp. 64:339-365 ( (May) ) 1939. 135. Anderson, E.; Haymaker, W., and Henderson, E.: Successful Sublingual Therapy in Addison's Disease , J. A. M. A. 115:2167-2168 ( (Dec. 21) ) 1940.Crossref 136. Turnoff, D., and Rowntree, L. G.: Successful Sublingual Therapy in Addison's Disease , J. A. M. A. 116:2016 ( (May 3) ) 1941.Crossref 137. Hampton, H. P., and Kepler, E. J.: Addison's Disease: Treatment and Prognosis , Am. J. M. Sc. 202:264-271 ( (Aug.) ) 1941.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Nov 1, 1941

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