THE DEVELOPMENT OF DIABETES MELLITUS IN ADDISON'S DISEASE

Abstract

THE occurrence of both adrenal cortical insufficiency and diabetes mellitus in the same individual is rare; reports of only twenty-two such instances are available. Each of these diseases is associated with abnormalities in carbohydrate metabolism in some respects antagonistic to the other and consequently the simultaneous occurrence of the two is of considerable interest. In the reports reviewed, diabetes waś established in the majority of the patients before the development of Addison's disease. (1–12). In four, however, both diseases were recognized simultaneously (13–16), while in three others, (17–19) the adrenal insufficiency antedated the appearance of diabetes. The presence of adrenal cortical hypofunction frequently alters the coexisting diabetic state. A number of these patients are reported to exhibit an unusual sensitivity to insulin (1, 3, 5, 8, 13, 14, 15, 18, 19) such as is characteristically found in Addison's disease alone. Severe hypoglycemic reactions are commonly mentioned and, in those patients with pre-existing diabetes, a fall in insulin requirement frequently follows the development of hypoadrenalism (4, 6, 8, 9, 10). However, in one instance, the daily dosage of insulin is reported unchanged (7), following the appearance of adrenal insufficiency and in ten others, either insufficient evidence is presented to establish this point or no reference is made to this problem.