Request for Reprints concerning Stress and the Adaptive Hormones.

5. The patient may be killed by an excess of salt, fluid or DCA; the venous pressure does not give warning of this. Autopsy may reveal pleural and pericardial effusions when there was no rise of venous pressure in life. Chronic adrenal insufficiency is usually due to destruction or atrophy of the adrenal glands but it may complicate hypopituitarism and it may accompany adreno-genital virilism. In all these diseases cortisone has a rational place in maintenance treatment as well as in the treatment of crisis. Patients with Addison's disease need much less cortisone than patients with rheumatoid arthritis; tuberculosis is probably not aggravated when cortisone is given in these physiological doses. Appetite improves, strength returns and mental powers increase. Hypoglycaemia is controlled. The risk of sudden crisis and death is diminished. Acute adrenal insufficiency can be forestalled if one recognizes that any stress such as hard physical work, infection or operation leads to an increased demand for hormone. In a patient who cannot respond to this demand because he lacks adrenal glands large amounts of adrenal extract or cortisone should be given. Patients with adrenal atrophy secondary to hypopituitarism or with unilateral atrophy due to a contralateral tumour which is to be removed present a special case; in them the adrenal glands may be stimulated with adreno-corticotropic hormone.