In a recent article, we1 reported a case of malnutritional edema which exhibited a unique clinical syndrome and a degenerative lesion of the suprarenal glands at autopsy. The outstanding clinical features of the syndrome were extreme emaciation with complete loss of body fat, asthenia, anorexia, polyneuritis, trophic ulcers, a high level of nonprotein nitrogen in the blood, absence of pigmentation and hypotension. It was suggested that the syndrome was that of chronic suprarenal insufficiency, analogous to the similar state in animals produced by bilateral suprarenalectomy.
That chronic suprarenal insufficiency is not a rare condition is shown by the fact that we are now able to report three additional cases, two of which have come to autopsy. Interest has also been aroused in another aspect of the syndrome. One of us (M. P.) has called attention to the resemblance in the later stages between pellagra and chronic suprarenal insufficiency.2