OTHER PATHOLOGICAL ABNORMALITIES 357 



paralytic ileus, thyrotoxicosis, diabetes, obesity, progeria, 

 osteomalacia, rickets, peptic ulcer, bronchial asthma, cancer, 

 etc. have been attributed to adrenal insufficiency or hyper- 

 activity. The evidence for this association is so unconvincing 

 and in many cases so obviously fallacious that we need not 

 consider it here. In the following sections shall be discussed 

 a number of clinical conditions in which the involvement of the 

 adrenals is unquestionable, although the significance of the 

 adrenals in the clinical condition is in many cases unknown. 



ANENCEPHALY 



The remarkable hypoplasia of the adrenals in anencephalic 

 monsters was observed as early as 1723 by Morgagni. 55 

 Meckel 447 and Nagel 464 claimed that the adrenals were absent 

 in these monsters and that their absence was responsible for the 

 maldevelopment of the reproductive organs. Although one 

 still finds these views quoted in recent texts it has been re- 

 peatedly shown that they are erroneous. As shown by 

 Meyer, 454 in the five-month anencephalic monster the adrenals 

 may be completely normal. At birth they appear much 

 smaller than the normal glands but this hypoplasia as Elliott 

 and Armour 182 first showed is due to the absence of what they 

 termed the "fetal" cortex or what we have designated as the 

 androgenic zone. The other two components of the adrenal — 

 the medulla and the cortex proper — are normally developed 

 so that the glands really resemble a miniature adrenal of a one- 

 year old child. Microscopically too the adrenals appear 

 normal except for this absence of the androgenic zone of the 

 new-born. 



The absence of the androgenic zone in anencephaly might be 

 anticipated if we accept the view that the androgenic zone is 

 associated with the development of the reproductive system. 

 It is possible, however, that the maldevelopment of the hy- 

 pophysis which occurs in anencephaly is the primary cause of the 

 failure of the androgenic zone for this gland, as we have seen, 

 and the androgenic zone may be closely related. 



