318 CLINICAL CONSIDERATIONS 



the view that adrenal atrophy is due to a chronic inflammation. 

 The pathological picture closely resembles that encountered 

 in yellow atrophy of the liver. 668 Brenner 84 considered the 

 atrophy to result from a slow necrosis due to some toxin. The 

 cells which remain unaffected tend to undergo compensatory 

 hypertrophy and form adenomatous nodules which are in turn 

 attacked or become exhausted. 



In Barker's 39 three cases of adrenal atrophy the medulla was 

 normal while the cortex was reduced to a narrow strip. The 

 remaining cortical cells were large, deeply stained, and pig- 

 mented, with numerous lymphocytes interspersed between the 

 cortical layers. In a few places were areas of recent hemor- 

 rhage. The diffuse nature of the destruction and the fact 

 that it is bilateral point to a toxic atrophy or a low grade in- 

 flammatory process of unknown cause. 39 - 48: 



In general, as in the six cases described by Wells, 668 there 

 is a selective necrosis of the cortical cells with much less visible 

 injury to the elements of the medulla. The other changes 

 observed in the adrenals appear to be secondary to this selec- 

 tive necrosis and consist of attempts at regeneration by pro- 

 liferation and hypertrophy. According to Wells it is impos- 

 sible to say if the partial loss of medullary tissue is due to the 

 same agency as is responsible for the cortical injury or if the 

 medullary destruction is the result of the extensive lymphoid 

 infiltration which follows the destruction of the cortex. 



A condition closely resembling adrenal atrophy as it occurs 

 clinically is sometimes seen in rats subjected to an incomplete 

 adrenalectomy. In such animals hypertrophy of the remain- 

 ing fragments of the adrenals maintains them in normal health. 

 In some animals, however, after a variable period of time, the 

 hypertrophied adrenal tissue undergoes atrophy and the 

 animal develops a fatal adrenal insufficiency. On microscopic 

 examination the hypertrophied fragments of cortical tissue, 

 which had maintained the animal in good condition following 

 adrenalectomy, present a picture resembling that observed in 

 adrenal atrophy as it occurs in man. 



