This is a rare, chronic disease, more often occurring in men, that
is characterized by muscular and vascular weakness, digestive
disturbances, and pigmentation. Tuberculosis of the adrenals has been
the most constant lesion found. In others, syphilis and atrophy have
been noted, while in a few the condition seemed to be functional. It
should be remembered that it is possible that lesions elsewhere in
the chromaffin system may be the cause in some cases, for all the
chromaffin tissues secrete adrenalin.
It is quite likely that in most cases there is some constitutional
defect of the chromaffin system which underlies a certain tendency to
the disorder. Infections, injuries, physical and mental strains may
lower resistance and predispose to the condition.
Osteopathic lesions of the splanchnics may congest the organs, or
derange the secretions, or be of such a character that hemorrhages
result, or fibrous changes follow, that would definitely incapacitate
the cells and lower resistance.
=Pathologically=, the most common change is tuberculosis. Next in
importance are atrophy and interstitial inflammation. Cancer of the
organs has been noted in a few. The adrenal ganglia, the semilunar
ganglia, and the solar plexus are often involved. The thyroid gland may
be altered, which, when affected, is usually decreased in size. Brown
atrophy of the heart is common.
=Symptoms.=—An insidious onset with muscular weakness, languor, and
weak action of the heart are generally the first symptoms. Digestive
derangements, such as nausea, hyperacidity, loss of appetite, may occur
at the same time, or shortly succeed the general debility. Headache,
insomnia, and depression frequently take place. Pigmentation, usually,
shortly follows, though there are cases where it is only slightly
noted. The disease is very chronic, of several years duration, with
periods of intermission. Occasionally, a case runs a very rapid course.
The general weakness is most noticeable. There is low blood pressure.
The derangement of the stomach and intestines is characteristic. And
the pigmentation, which at first is light yellow later assumes a dark
brown color. The pigmentation may be more or less general, but the
axillæ, nipples, genitals, the palms of the hands, and the neck, waist
or wherever the clothing presses upon the skin, are most pigmented. And
pigmentation of the mucous membrane may be noted.
=Diagnosis.=—In typical cases, where there is esthenia, pigmentation,
and gastro-intestinal disturbances, the diagnosis is not difficult.
Where the clinical picture is incomplete, the diagnosis may be very
difficult.
Pigmentation may occur in several other disorders, notably: in bronzed
diabetes, abdominal malignancy, tuberculosis of the peritoneum,
exophthalmic goiter, pellagra, marked intestinal stasis, stomach ulcer,
pernicious anemia, certain skin diseases, etc., so great care has to be
taken in atypical cases.
=Treatment.=—General treatment, with special attention to the adrenal
innervation, diet, rest, and fresh air will accomplish something. In
functional derangements, which are very few, recovery may follow.
But owing to the often constitutional defect, the probability of
tubercular, syphilitic, and other serious lesions, the prognosis is
unfavorable.