356 THE DISEASES OF THE SUPRARENAL APPARATUS 



have taken against the assumption of a functional increase of the chromaffin 

 tissue in certain forms of diabetes mellitus, does not seem to me a priori to 

 be justified. 



2. Tumors that Proceed from the Cortex 



These appear to possess greater clinical interest than the tumors of the 

 chromamn tissue. The knowledge that they may be associated with hyper- 

 function of the cortical system is one of the achievements of recent years. In 

 a clinical respect we can distinguish two groups of cortical tumors. In one 

 of the groups belong chiefly the sarcomata, lymphosarcomata, carcinomata, 

 alveolar sarcomata, endotheliomata, the melanotic carcinomata, and the cysts 

 (literature in Bullock and Sequeira, Frew, Glynn, Tilestone, Winkler, Hanschen, 

 and Arnaud}. These seem to bring forth only the usual symptoms of a 

 benign or malignant tumor. We shall not discuss this group any further. 

 The other group embraces the numerous cases of adenomata of the cortical 

 substance. 



These show great diversity in their point of departure. They may pro- 

 ceed from the cortex itself, or may originate in the separated germs of the 

 cortical system in the kidney, or in the genitalia, etc. The process concerned 

 in such adenomata may be that of a simple hyperplasia, that may either run 

 its course without symptoms or give rise simply to the local manifestations of 

 tumor, or may assume malignant character, and then show great inclination 

 for the formation of metastases. Finally these tumors may, without the men- 

 tioned tumor symptoms, lead to profound alterations of the organism, that 

 with a certain probability may be regarded as the expression of a hyperfunc- 

 tion of the cortex. Before I enter into the consideration of the clinical mani- 

 festations, I should like to refer to the demonstration of Bournemlle that in 

 idiots with "sclerose tubereause du cerveau" there are regularly found in the 

 cortex of the suprarenals lumps that Pellizzi regards as adenomata of the 

 suprarenals. 



The hypernephromata consist in round, oval, or polygonal cells, of an epi- 

 thelial character. The cells are often of many shapes. As the suprarenals 

 are of mesodermal origin, it is readily intelligible that the cells often assume a 

 mesodermal character, and in their histological structure approach primitive 

 sarcomata (Glynn). They are different, however, from the suprarenal sar- 

 comata proper; true lumina are never observed in them (Woolley). 



The simplest form clinically is represented by so-called Grawitz tumors. 

 These may originate in the kidneys (Grawitz) or the ovaries (Vonwiller) or in 

 the tail of the pancreas (R. Mohr). Lately their origin from separated germs 

 of the suprarenals has been combated by Stoerck and Zehbe, while R. Mohr 

 has again arrayed himself for this genesis. In the clinical respect it is signifi- 

 cant that they are never associated with alterations in the genital sphere. 

 This without doubt speaks for the view of Stoerck and Zehbe. At most we 



