ADDISON'S DISEASE AND DIABETES MELLITUS IN THREE PATIENTS

Abstract

IN 1932 (1) the writer described a case of diabetes mellitus developing in a lad of 16 years of age with pre-existing Addison's disease. Autopsy revealed atrophy of the cortex of both adrenal glands and of the islets of Langerhans. In the present paper 2 further cases of the coexistence of Addison's disease and diabetes mellitus are recorded, one coming to autopsy; and a résumé is given of 15 other cases recorded in the literature, in which autopsies were recorded, and 6 additional cases without autopsies. PHYSIOLOGY Adrenalectomy results in lowering of blood sugar, particularly after starvation, and in the terminal phase death from hypoglycemia. In some species, e.g. marmots, other effects on carbohydrate metabolism are depletion of liver glycogen and to a lesser extent of muscle glycogen, increase of blood lactates and increase in the rate of metabolism of glucose (2, 3, 4). These effects are reversed or prevented by the administration of an adrenalin- free extract of the adrenal cortex, or by any of the 11-oxysteroids that have been isolated from the adrenal cortex, e.g. corticosterone, 11-dehydrocorticosterone, and 11-dehydro 17-hydroxycorticosterone (Kendall's compound E). This group of 11-oxysteroids also has a diabetogenic action as has been demonstrated in the partially depancreatized or phloridzinized rat; and the glucose-nitrogen ratio of 3.6 to 1.0 indicates that the source of the extra glucose is protein. There is also a deposition of hepatic glycogen and a depression of glucose oxidation, as shown by lowering of the respiratory quotient. The 11-oxysteroids also counteract the hypoglycemic action of insulin (4, 5, 6, 7).