ISOLATED SYMPTOMS DUE TO SUPRARENAL CORTICAL FAILURE 351 



An indication as to the direction in which are to be found manifestations 

 of deficiency of the suprarenal cortex is found, under certain circumstances, 

 in adenomata of the suprarenal cortex. We shall see later that in such 

 hyperplasia of the cortex there occurs in youth abnormally rapid growth of 

 the organism and premature development of the secondary sexual characters 

 and the genitalia, and in adults a tendency to abnormal hairiness. Hence 

 arises the thought that when manifestations of the opposite kind are present 

 there may exist a cortical insufficiency. 



Moreover, in the chapter on the hypophysis I have reported a case of 

 hypophysial dystrophy in which the disease first developed in later life and led 

 to a marked retrogression of the hairiness on the trunk and on the face. In 

 this case both suprarenals were found to be highly sclerosed and we shall see 

 later in the consideration of the multiple ductless glandular sclerosis that in 

 man a retrogression of the secondary sexual characters may indeed set in as 

 the result of the failure of the function of the sexual glands, but that in 

 woman the mere loss of the function of the sexual glands is not usually fol- 

 lowed by distinct retrogression. First in cases in which the sclerosing process 

 involves numerous ductless glands does there seem to be in women a distinct, 

 and in men a marked retrogression of the hairiness and the genital organs. 



In the cases of multiple ductless glandular sclerosis in which there have 

 been autopsies there is always to be found a marked sclerosis of the supra- 

 renal cortex. Further there should be observed in eunuchoidism whether in 

 rare cases there does not exist, in addition to the hypoplasia of the sexual 

 glands, a hypoplasia of the suprarenal cortex. 



Finally Variot and Pironneau have described a case which was character- 

 ized by marked disturbance in growth, absence of any hairiness at all (eye- 

 brows, lashes, and almost complete baldness of the head). They have desig- 

 nated this case "nanisme type senile" and refer to two entirely analogous 

 observations by Gilford Hastings and Sir [Jonathan} Hutchinson. In the 

 last case the suprarenals were found to be sclerosed. Variot therefore con- 

 cludes that these vegetative disturbances depend on a loss of the function 

 of the suprarenal cortex. It seems to me, however, that in the case of Hutch- 

 inson there was an insufficient examination of the other ductless glands. Also 

 Gilford Hastings points this out, and I hold that it is not impossible that 

 this case constitutes multiple ductless glandular sclerosis in childhood, al- 

 though I am not in a position to prove this. Perhaps some objections may 

 be made against this view. At least I shall speak again of these cases under 

 the consideration of multiple ductless glandular sclerosis. 



It is also doubtful whether the dwarf described by v. Recklinghausen 

 should be grouped under cortical insufficiency. In a dwarf eighteen years 

 old who had died in convulsions, v. Recklinghausen found an apparently 

 chronic tuberculous caseation of both suprarenals. The individual was 95 

 cm. tall and weighed 10)^ kilograms. The measurements correspond to about 



