addison's disease 317 



microscopic examination of the fatty connective tissue will 

 reveal some remnant of islets of cells resembling those of the 

 cortex. These were found by Crosby 140 near the superior poles 

 of the kidneys embedded in retroperitoneal fat. In most cases 

 the adrenals are shrunken to a quarter or less of their normal 

 size. 84, 130 



Considerable difference of opinion exists in the literature 

 regarding the nature of the atrophy affecting the adrenals. 

 Various descriptive terms have been applied depending upon 

 the author's opinion regarding the nature of the process. The 

 terms idiopathic, primary, or simple atrophy have been fre- 

 quently used to indicate that the process is of the nature of 

 an aplasia. Others have considered the process, in some 

 cases at least, to be inflammatory in origin but in most cases 

 the histological picture does not conform with that of an in- 

 flammation. The assumption that the process is due to a toxic 

 agency led Kovacs 364 to apply the term "cytotoxic contracted 

 adrenal." Cirrhosis, chronic dystrophy, hypoplasia, etc. are 

 other terms which have been frequently used. 



The process is not a simple atrophy in the sense that there 

 is no shrinkage due to atrophy of the cellular elements. There 

 is instead a necrosis of the parenchyma which leads to the dis- 

 appearance of the cells. The expression "primary contracted 

 adrenal gland" suggested by Guttman 260 is probably most ac- 

 curate considering the unknown nature of the etiologic agent 

 causing the lesion. We shall, however, retain the simpler ex- 

 pression "atrophy" in the present volume. 



The older view advanced by Neusser 468 and Wiesel 678 that 

 adrenal atrophy is part of a congenital hypoplasia of the chro- 

 maphil tissue, in general, is no longer tenable. Pathological 

 studies indicate that the process is acquired. Simmonds 573 con- 

 sidered the etiology to be tuberculosis or syphilis but his views 

 have not been substantiated by recent observers. The absence 

 of an inflammatory hyperplasia of the interstitial tissue or of 

 any inflammatory reactions around the glands speaks against 



