CONDITIONS OF HYPERFUNCTION OF THE SUPRARENAL APPARATUS 357 



must assume that the Grawitz's tumors are strumas of the suprarenals that 

 analogously to strumas of the thyroid do not tend to be associated with 

 manifestations of hyperfunction. 



When the Grawitz's tumors are of large growth they may lead to local 

 oppressions (pains in the lumbar region, intercostal or femoral neuralgias, 

 and when there is pressure on the kidneys to hematuria, albuminuria, cysturia, 

 etc.), or they degenerate malignantly and lead to metastases and cachexia. 

 Westphal has gathered twenty-four cases from the literature, and has added 

 seven cases from his own statistics. 



In Grawitz's tumor there is frequently a tendency to formation of cysts 

 due to softening, with characteristic chocolate-colored content, which is 

 eventually demonstrable on puncture. 



It is true that Westphal adduces symptoms that indicate a hyperfunction 

 of the chromaffin tissue. In two of seven cases he found temporary glyco- 

 suria, in three cases a relative increase in the neutrophilic cells and a distinct 

 increase in blood-pressure in the early stages. I believe that these symptoms 

 are only of a secondary nature, called forth by an initial irritation of the 

 medullary substances by the growing tumor. It is worth mentioning that 

 Bittorf in two cases of unilateral hypernephroma also found symptoms of an 

 Addison's disease, emaciation, lassitude, pigmentations, and low blood-pres- 

 sure. These cases also showed a lymphocytosis. It seems to me that this 

 furnishes a corroboration of my view that the manifestations on the part 

 of the chromaffin tissue (irritation or deficiency) are only of a secondary 

 nature. Bittorf also observed slight psychical- symptoms in his case and 

 believes that they are of diagnostic importance and they do not occur in 

 tumors of the kidneys (v. Strumpell}. Both Bittorf 's cases were cured on 

 operation, only the pigmentations remaining unaltered. 



Perhaps the following two cases also belong to this group, v. Neusser 

 mentioned a twenty-five-year-old man with very tense pulse, multiple hemor- 

 rhages in the brain. The section showed a carcinoma of one suprarenal. 

 Vascular system and kidneys were normal. 



In addition v. Neusser cites a case of Frankel's, an eighteen-year-old girl 

 with headaches, vomiting, and high pulse tension. Section showed a vas- 

 cular neoplasm of the left suprarenal; the kidneys were normal. Here, too, 

 can the hyperfunction of the chromaffin tissue be regarded as an irritative 

 symptom. Conversely in rapidly growing cortical tumors symptoms of de- 

 ficiency of the chromaffin tissue may occur. 



Of very great interest for the knowledge of the internal secretions are 

 those adenomata of the suprarenal cortex that are associated with hyper- 

 function of the cortex. In the clinical picture of these cases there seems to be 

 an appreciable difference according to whether they develop in the entirely 

 childish, or in the juvenile, or in the adult organism. 



I. With the development of such hyperfunctionating cortical tumors in 



