addison's disease 319 



Amyloid degeneration. Amyloidosis of the adrenals, which, 

 as a rule, involves only the cortex, is an occasional factor in the 

 etiology of Addison's disease. Bronfin and Guttman 94 in a 

 series of 100 necropsies on patients dying of tuberculosis ob- 

 served 14 cases of amyloid infiltration of the adrenals. In 5 of 

 these cases a diagnosis of Addison's disease was made during 

 life. In some cases, symptoms suggestive of Addison's disease 

 were present while the remainder showed no symptoms indica- 

 tive of this disease. Histological study of the adrenals showed 

 that a definite relation existed between the extent of the amy- 

 loid involvement of the adrenal cortex and the symptomatology 

 (notably asthenia and gastro-intestinal symptoms). 



Amyloid degeneration of the adrenals, as of the spleen or 

 liver, results from chronic suppurations, tuberculosis, or 

 syphilis. The amyloid is deposited chiefly in the fasciculata 

 but may extend throughout the cortex and the medulla, com- 

 pressing the cells. 504 



Parenchymatous degeneration, with the formation of hyaline 

 or colloid droplets, have been described, but it is questionable 

 if these are not post-mortem or agonal changes. These occur 

 usually in the medulla. Fatty degeneration of the adrenal 

 cortex has been noted in several cases of Addison's disease. 417 



Malignant growths. Although the adrenals are occasionally 

 the site of primary or metastatic malignant growths, Addison's 

 disease is rarely caused by such invasions. 163 - 241 This is prob- 

 ably to be accounted for by the fact that so large a part of the 

 glands must be destroyed before clinical symptoms of insuffi- 

 ciency are elicited. In most cases death from the malignancy 

 intervenes before such extensive destruction of the adrenals 

 has occurred. 417 



Syphilis. There have been a number of clinical reports of 

 cases of Addison's disease attributed to syphilis. These re- 

 ports have been based on the favorable reaction of the patients 

 to antisyphilitic treatment. 652 - 565 



Syphilitic lesions in the form of gummata with caseation, 

 fibrosis, and infiltration of the surrounding tissues, however, 



