360 CLINICAL CONSIDERATIONS 



lateral hemorrhages following acute septic conditions have 

 resulted in symptoms simulating peritonitis and rapid death 

 from acute adrenal insufficiency. Such hemorrhages are apt to 

 occur in leukemia or other conditions in which there is an 

 hemorrhagic diathesis. 230 



Death in the new born has been ascribed in some instances 

 to hemorrhage into the adrenals. The hemorrhage observed 

 in the androgenic zone of the new born has, however, been 

 mistakenly attributed to injuries suffered during delivery, 

 whereas in reality, as Landau 376 showed, such hemorrhages are 

 part of a physiological process, and are observed in cases of 

 infants delivered by Caeserian section. It is possible that the 

 normal hemorrhage and diapedesis of the androgenic zone 

 might result in an unnatural extravasation of blood particu- 

 larly when aggravated by the trauma of a difficult delivery. 

 Such hemorrhages may, if extensive, cause death by inter- 

 ference with the normal cortical function. Large cystic hema- 

 toma have been produced which in rare cases have ruptured 

 through the capsule and filled the retroperitoneal space. 

 Adrenal hemorrhages of sufficient magnitude to cause death are 

 rare in adults but are found more frequently in infants dying 

 of unknown cause about one day after birth. 390 Traumatic 

 hemorrhages of the newborn are acquired during passage 

 through the birth canal (particularly in breech presentation), 

 or by slapping the lumbar region in attempts at resuscitation. 408 



Small hemorrhages are frequently observed in general in- 

 fections, intoxications, burns, and diseases in which there is an 

 hemorrhagic diathesis. Such hemorrhages are replaced by 

 pigmented scar tissue, calcified nodules, or the formation of 

 bone. 230 - 432 



The adrenals are also occasionally subject to other vascular 

 lesions, passive congestion, thrombosis, infarction, or em- 

 bolism. Passive congestion of the adrenals has been observed 

 in obstruction of the portal circulation, in cirrhosis of the liver, 

 and in conditions of general circulatory insufficiency. Throm- 



