340 THE DISEASES OF THE SUPRARENAL APPARATUS 



bation (reduction in weight). With this there exists complications with frequently 

 recurring articular rheumatism. 



Pathological Anatomy. Congenital errors of development of the supra- 

 renal are often found combined with other malformations. Zander quotes 

 forty-two cases of hemicephaly in which the suprarenals were always small. 

 This finding is also constant with other malformations, if there is an absence of 

 the anterior cerebral hemispheres. There apparently exists in such cases 

 aplasia of the cortical system. At least Elliott and Armour in a case of anen- 

 cephalus found the suprarenal medulla and the paraganglia normal, while 

 the cortex was entirely absent. Czerny found the medullary substance 

 entirely absent in five cases of congenital hydrocephalus. Ulrich observed 

 in an adult complete aplasia of the suprarenal medulla; here the paraganglia 

 must have been especially well developed. 



Important practically is the hypoplasia of the chromamn tissue described 

 by Wiesel, Hedinger, Goldzieher, and others, which is mostly associated with 

 status lymphaticus and sometimes with great parenchymal value of the 

 thymus gland. According to Wiesel such individuals are especially predis- 

 posed to Addison's disease. Acute destruction of the suprarenals may occur 

 as a result of hemorrhage of thrombosis of the suprarenal veins (Virchow, 

 Carrington, Karakaschejf, Goldzieher, [Lavenson, Hektoen, Ellis]) and others or 

 through suppuration (Janowsky). Much more frequent are simple atrophy 

 or sclerosis (Rolojf, Simmonds, Bittorf, Goldzieher). 



Bittorf collected forty-seven cases of true atrophy or cirrhosis of the supra- 

 renal glands, adding to these three cases of his own. In such cases the supra- 

 renals are much decreased in size or entirely shrunken and often grown 

 together with the surrounding tissue. Microscopical examination usually 

 shows a very considerable reduction of the parenchyma, fattening and 

 eventually necrosis of the cells. With the cirrhosis, one finds thickening 

 or obliteration of the vessels, and growing together with the surround- 

 ings. Sometimes the sclerosis exists on a luetic basis (Schwyzer, Esser}. 

 Esser found gummata in connection with symptoms resembling Addison's 

 disease in a new-born. According to Lichtwitz, pigmentations occur in all 

 these cases. This author found the condition complicated with scleroderma 

 in four cases in the literature, adding a fifth case. Most commonly, how- 

 ever, tuberculosis of the suprarenals is found bilateral, not rarely isolated. 

 Often, however, other tuberculous foci in the body are found. Among five 

 hundred forty-nine cases from the literature, Elsdsser found isolated tuber- 

 culosis of the suprarenals in 17 per cent., in 48 per cent, combination with 

 pulmonary tuberculosis, and tuberculous foci in other parts of the body in 

 the rest of the cases. 



In four hundred seventy-two cases the lesion of the suprarenal was bi- 

 lateral. The suprarenals may be destroyed also by tumors. Bittorf re- 

 ports two cases of hypernephromata with symptoms of Addison's disease. 



