The cause of most cases of human obesity is unknown. Specific alterations in the activity of the autonomic nervous system may mediate and perhaps cause obesity in animal models. We therefore looked for alterations in autonomic activity in human obesity. Fifty-six healthy men with various percentages of body fat underwent autonomic testing while at rest. Significant correlations were found between the percentage of body fat and the variation in the R-R interval after beta-adrenergic blockade (r = -0.30, P less than 0.03), the heart rate (r = 0.30, P less than 0.03), the plasma norepinephrine concentration (r = -0.30, P less than 0.05), the plasma epinephrine concentration (r = -0.49, P less than 0.001), and the pupillary latency period (r = 0.39, P less than 0.01). Each of these variables reflects the activity of the sympathetic nervous system or parasympathetic nervous system or both. Depressions in sympathetic and parasympathetic activity were significantly but weakly associated with increasing percentages of body fat. These associations indicate that in obese persons, autonomic changes, though not necessarily causal, involve several organ systems. We suggest that autonomic alterations are important in human obesity, as they are in animal obesity. A disordered homeostatic mechanism may promote excessive storage of energy by decreasing sympathetic activity, while defending against weight gain by decreasing parasympathetic activity. The use of autonomic profiles holds promise for classifying human obesity and identifying obese patients at increased risk for various disorders.

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We describe a patient who presented with constitutional symptoms, severe hypertension, and purpuric lesions over the knees, thighs, and penis. The patient was eventually diagnosed as having multiple endocrine neoplasia type II, with cutaneous leukocytoclastic vasculitis. The cutaneous vasculitis persisted despite treatment with highdose systemic corticosteroids, but rapidly resolved after the removal of bilateral pheochromocytomas. This case demonstrates cutaneous leukocytmlastic vasculitis in association with pheochromocytoma.Necrotizing vasculitis is a term used to describe the inflammation and necrosis of blood vessels that is seen in a broad spectrum of disorders. The hypersensitivity group of the necrotizing vasculitides is commonly encountered (1) and is characterized by small vessel involvement. Hypersensitivity vasculitis, or leukocytoclastic vasculitis (LV), as it is commonly called, has many potential etiologies (2). Among the possible causes of LV are drugs, infections, connective tissue disease, or on rare occasions, malignancy (3). We describe a patient who had cutaneous LV in association with multiple endocrine neoplasia (MEN) type 11, and the LV was related, specifically, in our opinion, to bilateral pheochromocytomas. To our knowledge, this is the first report of LV associated with pheochromocytoma. Case report. The patient, a 32-year-old white heterosexual man, presented in January 1987 with a 3 4 d a y history of fever, chills, headache, anorexia, nausea, vomiting, arthralgias, myalgias, heat intolerance, and lesions on his legs. His medical history was significant for acute hepatitis B infection in August 1986, moderate alcohol use until the diagnosis of hepatitis, peptic ulcer disease in 1984, and congenital duodenal atresia. During hospitalization in 1986, he was normotensive, and his medications at the time of this admission included promethazine, acetaminophen, and aspirin.On admission to the hospital, the patient was thin and flushed, but well-oriented. His blood pressure was 210/150 mm Hg, heart rate was 128 beatdminute, and temperature was 993°F. His sclerae were ictenc, and there were retinal hemorrhages in both eyegrounds. He had a grade IYVI systolic ejection murmur at the left upper sternal border, which radiated into the carotid arteries bilaterally. The abdomen was diffusely tender, but there was no rebound tenderness. His bowel sounds were normal. Tender, slightly palpable, reticulated purpuric lesions were distributed over the penile shaft, thighs, and knees (Figure 1). Seven cafk-au-lait spots, measuring 2.0-5.0 cm in diameter, were present on the patient's trunk and extremities, and axillary freckling was noted. Physical examination results were negative for thyromegaly , mucosal neuromas, neurofibromas, and localizing neurologic signs.Laboratory evaluation at admission showed the following values: white blood cell count 20,8W/mm3, with a normal differential cell count, erythrocyte sedimentation rate (Westergren) 34 mm/hour (normal 0-20), blood urea nitrogen 72 mg/dl (normal 5...

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