CLINICAL STUDIES IN ADDISON'S DISEASE

In following a series of one hundred and fifty-eight cases of Addison’s disease’l it is apparent that two outstanding changes have occurred during the past decade : 1. There has been a marked decrease in the proportion of patients with tuberculosis as the etiology of Addison’s disease; ie., tuberculosis is responsible now for adrenal insufficiency in only half the authors’ patients. Whereas, in the past, 80 per cent of patients with Addison’s disease died within two years,2 50 per cent of the patients in the authors’ series have survived a seven-year period of treatment (FIGURE 1). This remarkable improvement in life expectancy appears to be due in large measure to (a) the extensive use of synthetic desoxycorticosterone acetate,§ particularly as pellets implanted subcutaneously, combined with the use of whole adrenal cortical extract in emergencies when food intake is not adequate, and (b) the decrease in the incidence of tuberculous etiology, with its extremely unfavorable effect on the general management and prognosis of Addison’s disease and the always present danger of a recurrence of activity. With an increase in the period of survival, it is becoming steadily more important to improve the physical and mental status of these patients to a point where they can become self-supporting, or at least not remain a complete burden to society. The availability of 11-oxy-steroids in addition to desoxycorticosterone would appear to be a prerequisite in this endeavor. 2 . There has been a considerable prolongation of life.