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Manifestations of autonomic neuropathy which occur in diabetes mellitus include nocturnal diarrhea or constipation with associated atony of the stomach and dysfunction of the small bowel, sphincter disturbances, atonic bladder, orthostatic hypotension, sudomotor and pilomotor disturbances, and impotence (see reviews by Joslin 1 and Rundles 2 ).Although only one of these disorders may be present, usually several occur together. Peripheral nerve involvement has also been present in the majority of the cases reported.The diverse structures, functions, and locations of the organs affected suggest that the entire autonomic nervous system is vulnerable. It therefore seems possible that other, hitherto unrecognized, neurogenic syndromes may exist in diabetes. A deliberate search for such syndromes was undertaken and the findings concerning gallbladder dysfunction in a group of unselected diabetic patients form the subject of this preliminary report.MATERIALS AND METHODS Cholecystography was performed in two groups of patients, using Telepaque or Biligrafin.Group A consisted of thirty-five patients with diabetes mellitus of various degrees of severity.Nine of these patients were males, thirty-six to seventy-four (mean sixty-three) years of age, and twentysix were women, aged forty to seventy-two (mean fifty-nine) years. The insulin requirements of these patients varied between o and 72 units. Some were receiving tolbutamide treatment. None of the patients had ketosis or marked electrolyte disturbances during the period of examination.Fourteen patients had symptoms and/or signs suggesting chronic cholecystitis or cholelithiasis, and two others had compensated liver cirrhosis of the Laennec type. In these sixteen patients abdominal discomfort, if present, was not severe.

The surface of the X-ray shadow of the gallbladder was determined by a planimeter in 100 random patients examined for complaints suggesting gallbladder disease, in whom the viscus was well visualized and no gallstones were discernible. No correlation was found between the gallbladder size and body surface or sex.The mean surface of the gallbladder shadow in thirty-two diabetic patients was significantly larger than the mean surface in forty-three nondiabetic individuals. The frequency of large gallbladders (over 24 sq. cm.) was higher among the diabetic than the nondiabetic individuals.

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