EFFECTS ON THE SUPRARENAL GLANDS 43 1 



suprarenal changes to the production of edema appears somewhat uncertain, 

 but McCarrison concludes that " In the presence of a diet deficient in vitamin A 

 and B, in protein, and excessively rich in starch, oedema-production is associated 

 with derangement of adrenal function both as to its cortex and as to its medulla. 

 This disturbance of function is evidenced by great enlargement of the glands, 

 dispersal of lipoids from the cortex, and an increased epinephrine-content of the 

 medulla." Cramer ('23), however, found no marked changes in the suprarenal 

 glands of young rats on a tryptophan-deficient diet, with thyroid lesions and 

 myxedema. 



Hypertrophy of the human suprarenal glands in association with malnutri- 

 tional edema was also noted by Bigland ('20), Menzies ('20), and others 

 (reviewed by McCarrison '21). Enright ('20) appears to be the only observer 

 rinding an atrophy of the suprarenals in war edema. Tallquist ('22) also 

 claimed that tests in fatal cases showed adrenal and thyroid insufficiency. 



In pellagra (considered primarily due to protein deficiency), changes in the 

 human suprarenals have often been noted. Harris Cio) found capillary 

 hemorrhages, cellular infiltration and destruction, with extreme fatty (?) change 

 in the medullary cells. Kozowsky ('12) mentioned capillary hemorrhages. 

 Nicholls ('12, '13) observed that the suprarenals are not shrunken, but gave 

 no weights. Raubitschek ('15) stated that the suprarenals usually show no 

 characteristic changes, although Finotti and Tedeschi found nearly constant 

 " kleinzellige Infiltrationen und Bindegewebswucherungen auf Kosten der 

 Driisenelemente." Sundwall ('17) in one case found no distinct pathological 

 change; although there was slight sclerosis, with much lipoid substance in the 

 zona fasciculata and much pigment in the zona reticularis. 



Modinos ('16) in cases of pellagra in Egypt noted that the suprarenals were 

 nearly double the normal size, but this was not confirmed by Wilson ('16). 

 Morse ('16) in one case found the suprarenal cortex nearly normal; but the 

 medulla showed moderate atrophy and fibrosis, with dilated blood spaces. The 

 chromaffin cells were somewhat reduced in number. There appeared an infil- 

 trative chronic inflammatory reaction, with focalized collections of lymphocytes 

 and a few plasma cells. Roaf ('20) stated that the suprarenals are slightly 

 lighter in pellagra than in other wasting diseases. Boyd ('20) observed no 

 characteristic changes at necropsy, although the clinical features of pellagra 

 suggest a profound suprarenal inadequacy. 



In attempts to produce experimental pellagra, Rondoni ('15) found the 

 suprarenals deficient in adrenalin in guinea pigs on maize diet, and various 

 changes (degeneration and sclerosis) in structure were described by Rondoni 

 and Montagnani ('15) and Rondoni ('22). Rondoni ('19) stated that the supra- 

 renals form 0.12 per cent of the body weight in normal guinea pigs; 0.22 per cent 

 in the maize-fed; 0.27 per cent in the oat-fed; and 0.18 per cent in those starved. 

 The enlargement therefore appeared even greater in partial inanition than in 

 total inanition. 



In rickets, Cattaneo ('05) was unable to confirm Stoeltzner's ('04) theory of 

 a suprarenal and adrenalin deficiency as an etiological factor. Stoeltzner ('09) 

 still maintained that the suprarenals are primarily affected, and abnormally 



