THE ADRENALS AND ADDISON'S DISEASE G15 



thesis that exophthalmic goiter is due to parathyroid insufficiency, however, stand 

 the following facts: 



(1) Removal of one lobe of the thyroid often causes improvement or recovery 

 in this disease, yet with the lobe of the thyroid is generally removed the adjacent 

 parathyroid, which would decrease the amount of i)aralhyroid tissue, and make 

 worse any existing parathyroid insufhciency. (2) Therapeutic administration of 

 parathyroid tissue or extract has had no significant effect on the disease. (3) 

 No considerable or characteristic anatomical changes occur in the parathyroids in 

 exophthalmic goiter,'" while the great majority of all cases show changes in the 

 thyroid. (4) The parathyroids seem to have but slight influence on metabolism 

 (MacCallum), while metabolic abnormalities are very marked in exophthalmic 

 goiter/' 



The Adrenals and Addison's Disease^- 



Like the hypophysis, the adrenals are essentially double organs, 

 containing nervous and glandular tissues. The medulla is of sym- 

 pathetic nervous system origin, a part of the chromaffin" system, 

 which in most animals is enclosed in a layer of entirely different nature 

 and origin, the cortex being an epithelial structure, derived from the 

 urogenital anlage, and resembling most closely in structure (and per- 

 haps in function) the corpus luteum of the ovary. In some marine 

 animals, indeed (eels, sharks, etc.), the sympathetic tissue portion and 

 the cortical tissue exist as separate organs. 



The adrenal cortex seems to be related especially to the generative 

 system,^^ as shown by the following facts: 



1. The embryologic origin in the urogenital anlage, and the histologic struc- 

 ture which is similar to the corpus luteum. 



2. In many animals there occurs hypertrophy of the cortex during the breeding 

 season, and there are histological differences in the glands of males and females 

 (Kolmer). 



3. Many cases of sexual precocity have been observed in association with 

 tumors or hypertrophy of the adrenal cortex; and defective sexual development 

 has been found associated with atrophy of this tissue.^* 



4. The medulla increases relatively little in size after birth, while the cortex 

 increases with the development of the individual. 



Whether the cortex has other functions or not is not j'et known. ■'^ 

 Biedl has found evidence that cortical substance is essential for life." 

 Animals with accessory adrenals, which contain onlj' cortical substance, 

 withstand ablation of the adrenals proper, presumably because the 



*° MacCallum, Johns Hopkins Hosp. Bull., 1905 (16), 287. 



" The calcium excretion in exophthalmic goiter parallels the nitrogen (Towles, 

 Amer. Jour. Med. Sci., 1910 (140), 100). 



" Literature given by Bayer, Ergebnisse Pathol., 1910 (XlVo), 1. 



*^ The chrome reaction (observed in the adrenal medulla, carotid and coccygeal 

 glands and the sympathetic ganglia), as well as other reactions for these tissues, 

 is based on reduction of chromic acid to chromium dioxide by epinephrine (Ogata, 

 Jour. Exp. Med., 1917 (25), 807). 



^^See Kolmer, Pfltiger's Arch., 1912 (144), 361; Vincent, Surg., Gvn., Obst., 

 1917 (25), 299. 



" See Glynn, Quart. Jour. Med., 1912 (5), 157; Jump et al, Amer. Jour. Med. 

 Sci., 1914 (147), 568. 



••^ It does not have a marked effect on the development of tadpoles, hence dif- 

 fering from thyroid and thymus (Gudernatsch). 



*' See also Crowe and Wislocki, Bull. Johns Hopkins Hosp., 1914 (25), 287; 

 and Wheeler and Vincent, Trans. Roy. Soc. Canada, 1917 (11), 125. 



