Chapter XXII 



TUMORS OF THE ADRENALS 



Primary tumors of the adrenals are relatively rare, but they 

 are of great interest for the light a study of their clinical mani- 

 festations throws on the function of the normal gland. Of 

 46,000 hospital admissions examined by Gibson 220 only four 

 proved to be primary adrenal tumors. Metastatic growths, 

 on the other hand, are relatively frequent. Thus in a survey 

 of 371 malignant tumors which came to autopsy, Burke 100 

 found that 49 showed metastatic involvement of the adrenals. 



Such metastatic growths rarely, however, cause any clinical 

 manifestations, for death results from carcinomatosis before 

 sufficient destruction of cortical tissue has occurred to give 

 symptoms of adrenal insufficiency. The majority of malignant 

 tumors will metastasize to the adrenals but certain types do so 

 more readily than others, namely, tumors of the breast, 

 esophagus, stomach, testicle, penis, Hodgkins disease, and 

 malignant melanomas. Either gland may be involved de- 

 pending on the location of the primary growth. In many 

 cases metastases are found in the adrenal where there is no 

 general dissemination of the tumor. The medulla is more fre- 

 quently the site of the metastases than the cortex. 



We may subdivide the primary tumors of the adrenal accord- 

 ing to their site of origin as medullary, cortical, and androgenic. 

 Previous authors have considered all adrenal tumors as being 

 either medullary or cortical. The assumption made by the 

 present author that a large group of the tumors arising in the 

 cortex are derivatives of the androgenic tissue, although still 

 unproven experimentally, is a useful hypothesis which avoids 

 otherwise irreconcilable inconsistencies and is in accord with 

 all the known facts available at present. We shall defer our 



