addison's disease 321 



ker 39 found normal kidneys in only 7 of his 28 cases. Conges- 

 tion, diffuse tubular atrophy, chronic pyelonephritis, and renal 

 tuberculosis were observed in the other cases. The tubular 

 atrophy had the appearance of a toxic nephrosis and was pres- 

 ent in a third of the cases. 



The thymus is often persistent (cf. Chapter X) and the 

 spleen is enlarged and soft. There is general hyperplasia of 

 all the lymphoid tissues. Hedinger 291 found a status thymo- 

 lymphaticus in 7 of his 15 cases. 



Guttman, 260 in his comprehensive analysis of the cases of 

 Addison's disease reported in the literature, found no significant 

 changes in the thyroid. On the other hand, in the six cases of 

 Addison's disease due to adrenal atrophy, described by Wells, 668 

 there was a marked infiltration of the thyroid gland with 

 lymphoid cells. This infiltration of the thyroid gland with 

 lymphoid tissue has been described in Addison's disease of 

 tuberculous origin but is less marked and less frequent than 

 it is in cases of non-tuberculous origin. 668 



In a small proportion of cases, extensive alterations occur 

 in the sympathetic system (particularly the semilunar ganglion 

 and the solar plexus) which may extend into the central nervous 

 system. 



The hypophysis in some cases of Addison's disease shows a 

 diminution in the number and size of the eosinophil cells and a 

 scarcity of normal, well-granulated, basophilic cells. The 

 significance of these changes has been discussed in Chapter 

 XIV. 



The reproductive glands sometimes show atrophic changes. 417 



Considerable controversy has always raged regarding the 

 question as to whether the pathological changes in the adrenals 

 were alone responsible for the clinical manifestations of Addi- 

 son's disease or whether changes in other glands were in part 

 also responsible for these manifestations. A number of 

 workers described changes in the ganglia or the spinal cord to 

 which they attributed the manifestations of the disease rather 



