352 THE DISEASES OF THE SUPRARENAL APPARATUS 



those of a three- or four-year-old child. The body dimensions were well 

 proportioned. The epiphysial junctures were retained, the penis and the 

 testicles were rather small. If we were already disposed to regard a loss 

 of the suprarenal function as the cause of the disturbance in growth, we 

 would have to hold responsible the suprarenal cortex, as hypoplasia of the 

 chromaffin tissue rather produces a tall, weak, individual. I regard as more 

 likely that here we are dealing with a true dwarfism and that the supra- 

 renal caseation constitutes an accidental complication. 



On reviewing the preceding material, we find that it is a question if 

 the observations are to be referred to an isolated withdrawal of the cortical 

 function. The observations seem rather to suggest that from the cortex 

 there proceeds a furthering influence on the genital sphere and especially on 

 the hairiness, an assumption, as we shall see later receives essential support 

 through corresponding manifestations in hyperplastic conditions of the cortex. 

 These observations furnish no support for the assumption that loss of the 

 function of the suprarenal cortex leads to manifestations of intoxication. 



b. Conditions of Hyperf unction of the Suprarenal Apparatus 



Here we are interested especially in tumors of the suprarenal appara- 

 tus, which usually, but not always, are associated with conditions of hyper- 

 function. 



I. Tumors that Proceed from the Chromaffin Tissue 



These seem to be very rare. Kuster describes two cases of glioma of the 

 suprarenals, one affecting a fourteen-month child whose entire right supra- 

 renal had been converted into a tumor, while in the left suprarenal was 

 found a tumor occupying the site of the medulla. Numerous metastases were 

 present. 



In the second case the findings were accidental. Kuster regarded these 

 tumors as a glioma, Wiesel as a growth made up of formative cells of the 

 sympathetic, although Schilder has lately described a certain glioma of the 

 sympathetic and regards Kuster' s case as glioma. More recently there have 

 been described chromaffin tumors, in part too proceeding from the paragan- 

 glia, by Weichselbaum, Manasse, Stangl, Monckeberg, and Kolisko. Kolisko's 

 case (reported by v. Neusser and Wiesel) was that of a vigorous, otherwise 

 healthy, man who suddenly died during cocaine anesthetization on account 

 of the extraction of a tooth. Here was found a bilateral suprarenal tumor 

 made up of chromaffin tissue, and very rich in adrenalin. v. Neusser and 

 Wiesel regard this case as adrenalin intoxication. Very interesting is the 

 case of Wiesel, a tumor of the sympathetic in a two-year-old child with arterio- 

 sclerosis which resembled histologically the sclerosis produced experimentally 

 in animals by adrenalin. Hence it seems that these tumors can be associated 



