addison's disease 315 



found the causative agent to be: bilateral tuberculosis, in 

 68.3 per cent; primary atrophy, in 19.4 per cent; amyloid dis- 

 sease, in 1.7 per cent; and neoplasms, in 1.2 per cent of all 

 the cases. Fatty degeneration, pressure atrophy, venous 

 thrombosis, arterial emboli, and syphilis comprised the re- 

 maining 9.4 per cent. 



Hedinger 291 found tuberculosis in 14 out of 15 patients with 

 Addison's disease. In Coneybeare and Millis' 122 29 autopsied 

 cases, 22 had bilateral fibrocaseous tuberculosis of the adrenals 

 and 6 had simple atrophy. In the remaining case, remnants 

 of the adrenals could not be found. Philpott's 504 14 cases 

 comprised 7 cases of tuberculosis, 4 of metastatic carcinoma, 

 and 1 each of mycosis fungoides, simple atrophy, and amyloido- 

 sis. Barker 39 in his detailed account of the autopsy findings 

 in 28 cases, studied clinically by Rowntree, found tuberculosis 

 in 25 and atrophy in the remaining three. 



Tuberculosis. The fibro-caseous lesions of tuberculosis are 

 found in about 90 per cent of all cases of Addison's disease. 

 The greater interest in cases due to other causes results in 

 their being more frequently reported in the literature as isolated 

 case reports. Hence, collections from the literature give an 

 erroneous idea as to the relative frequency of the different 

 lesions. 260 Atrophy of the adrenals is found in about 10 per 

 cent of all cases. Vascular defects, malignant growths, syphi- 

 lis, and other conditions are the cause of relatively few of the 

 cases of Addison's disease. 



Tuberculosis affects the adrenals with more or less complete 

 caseation, with softening, fibrosis, or calcification. The glands 

 may be shriveled but most often are enlarged. 



Sections of the tuberculous glands show tubercles with en- 

 dothelial cells, giant cells, fibroblasts, and lymphocytes. 296 

 Acid fast bacilli can be demonstrated. 39 The necrosis differs 

 from the caseous necrosis of tuberculosis observed in other 

 glands and tissues in its yellow color and firm consistency. 



Some normal cortical tissue was observed by Barker 39 in 



