CONDITIONS OF HYPERFUNCTION OF THE SUPRARENAL APPARATUS 353 



with hyperf unction of the chromaffin tissue. For this also speaks the 

 associated cardiac hypertrophy that is so frequently found. 



Moreover, there should be mentioned here the case of Kawashima. In 

 this case were found multiple skin fibromata proceeding from the con- 

 nective-tissue sheath of the nerves, and also tumors of the suprarenal medulla. 

 Kawashima discusses the association of neurofibromata with diseases of the 

 nervous system. He points out that neurofibromata are very frequently 

 associated with general symptoms (disturbances of nutrition, intellectual dis- 

 turbances, gastrointestinal affections, certain visual disturbances, headaches, 

 spasms, depressed states, and alterations in the sexual sphere) and believes 

 that these as well as the general symptoms are the expression of an affection of 

 the nervous system. There should also be mentioned two cases of paragangli- 

 oma reported by M. Herde. Both cases were those of chromaffin tumors. 

 In one case there existed arteriosclerosis, in the other genuine "Schrumpf- 

 niere." Finally I mention a case of Sazuki's (chromaffin tumor of the 

 suprarenal medulla) and of E. Hedinger's (struma medullaris cystica supra- 

 renalis) . 



The question as to whether there exist conditions of hyperfunction of the 

 chromaffin otherwise than when due to tumor has been recently discussed. 

 It is noteworthy that numerous authors take the negative attitude concerning 

 this question, at least as far as chromaffin tissue is concerned. In tumors of 

 the chromaffin tissue we have learned to recognize a group of clinical condi- 

 tions, which we may regard as due, with great probability, to an increased 

 function of the chromaffin tissue. 



Are we then justified in regarding similar clinical conditions as the ex- 

 pression of a hyperfunction of the chromaffin tissue, even where a patho- 

 logico-anatomical substratum has not as yet been found for them? 



Originally French authors (Pilliet, V agues, Aubertin and Ambard) en- 

 deavored to explain the increase of blood-pressure in interstitial nephritis 

 by an increase in the function of the suprarenal cortex, as they often met with 

 strikingly large supra,renals in cases with hypertonia. Josue has assumed such 

 in the atheromatosis associated with hypertonia. After, however, we had 

 recognized the significance of the chromaffin tissue for the regulation of blood- 

 pressure, Beaujard regarded it as regulative against increased circulation of 

 toxic products in the organism, which would be conditioned on the lessened 

 eliminatory capabilities of the kidney. Apparently the chromaffin tissue 

 alone seems to be significant for the pathogenesis of this condition, in so far 

 as we might wish to bring it into correlation with the suprarenal apparatus. 

 The question should, however, be formulated as to whether secondary hyper- 

 functional conditions of the chromaffin tissue occur as the reaction to other 

 processes in the body, processes that are released eventually by a permanent 

 reflex condition of over-excitement of the centers of this system lying in the 

 medulla oblongata or in the brain stem; also we should consider the possibility 

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