The clinical significance of abnormal blood-pressures / by Sir Humphry Rolleston, Bart., K.C.B., M.D., Hon. D.Sc., D.C.L., LL.D., regius professor of physic in the University of Cambridge, England.

  • Rolleston, Humphry Davy, Sir, 1862-1944
Date:
[1928]
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Licence: In copyright

Credit: The clinical significance of abnormal blood-pressures / by Sir Humphry Rolleston, Bart., K.C.B., M.D., Hon. D.Sc., D.C.L., LL.D., regius professor of physic in the University of Cambridge, England. Source: Wellcome Collection.

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    with little or no palpable enlargement, it is interesting to note that Shapiro has taken quite a different view of their nature and describes them as a definite syndrome under the title “clinical symptomatic hyperepinephrinism.” The signs of this syndrome, of which he and Boas have now published eight examples, are increased basal metabolic rate (hyperthermia), high systolic blood pressures, rapid pulse, loss of weight, nervousness, and pigmentation. These signs are common to exophthalmic goitre, but in the new condition there was absence of sweating, of the fine tremor, well marked asthenia, gastro-intestinal crises, thyroid enlargement, of improvement under iodine or X-ray treatment, and in three cases after subtotal thy¬ roidectomy; another difference is that whereas the prognosis in Graves’ disease is usually good both as regards control of symptoms and life, the outlook in the new syndrome is bad, three out of the eight patients having already died. The obvious criticism, already made by Read, that these are cases of Graves’ disease with merely a coincident high blood pressure is met by the following objections that, in addition to other differences mentioned above, in Graves’ disease the diastolic pressure is normal or low giving rise to a large pulse-pressure, which Davies and Eason have shown to be correlated with hyperthyroidism and a raised metabolic rate, whereas in symptomatic hyperepinephrinism both diastolic and systolic pres¬ sures are high. For more than thirty years the possibility of a disease due to excessive or aberrant secretion by the medulla of the adrenals has been anticipated but not established; Shapiro does not mention any postmortem investigation of his three fatal cases, so presumably they were not obtained, but from the clinical point of view the occurrence of cases resembling Graves’ disease but with¬ out goitre and with a high diastolic and systolic pressure deserves further investigation. Reference may perhaps be made here to spontaneous gangrene which, like Raynaud’s disease, has been ascribed by von Oppel of Leningrad to excessive secretion of adrenalin by the adrenals; in 1921 he argued that excess of adrenalin, which Sicard in 1927 ascribed to stimulation of the adrenal medulla by the testicular hormone, produced spasm and secondary nutritional disturbance of the vessel walls consisting in endothelial desquamation and mus¬ cular degeneration so that thrombosis occurred (suprarenal arteriosis,