362 THE DISEASES OF THE SUPRARENAL APPARATUS 



scarcely suspected. In the books of Neusser and Wiesel on the diseases of the 

 suprarenal glands they are hardly taken up. As to what concerns the al- 

 terations in the organisms that occur in hyperplasia of the suprarenals, that 

 is in conditions of hyperfunction, it is worthy of note that they are different 

 according to the age at which such hyperplasia develops. Their action occurs 

 earliest in pseudohermaphroditism. Here their development occurs in fetal 

 life. That the development of such cortical hyperplasias stands in a causal 

 relationship with the development of pseudohermaphroditism is hardly at 

 all probable; when one considers that up to the present insufficient attention 

 has been paid to such relationship, it would not do to assume that the hyper- 

 plasias occur constantly in pseudohermaphroditism. It is much more likely 

 that they are only a partial manifestation of the malformation, which would 

 lend to them at all events a definite expression. It has already been men- 

 tioned, they occur almost exclusively in pseudohermaphroditismus femininus. 



In the age of childhood we see with development of the tumors of the 

 suprarenal cortex a premature development of the entire organism, a sort 

 of transient gigantism associated with potentized childish dimensions and 

 premature development of the genital organs, a clinical picture that in 

 almost all respects is similar to that observed in the development of tumors 

 of the pineal gland in childhood. Whether hyperplasia of the suprarenal 

 cortex is frequently present with tumors of the pineal in childhood is as yet 

 not certain. Up to the present it has been observed in one case only. As we 

 shall see later in the development of tumors of the sexual glands in childhood 

 there occur the same clinical pictures, even, if possible, better pronounced. 

 Here also future studies must decide as to the behavior of the suprarenal 

 cortex. Apparently there exists an intimate connection between these three 

 forms of premature development and it would not be unlikely that the bond 

 of union is the suprarenal cortex. At any rate, a certain influence of the supra- 

 renal cortex on the growth is evident; with this agrees also the occurrence of 

 cortical hyperplasia in acromegaly. Just as evident is a certain stimulating 

 influence on the development of the sexual glands. Apparently there exists 

 here a reciprocal correlation, as hyperplastic changes in the suprarenal cortex 

 occur during rut in animals and in pregnancy (Guiyesse, Stoerck and v. Haberer) . 

 In this also can be seen a certain relation of the suprarenal cortex to growth. 

 As is known, women who are pregnant and whose epiphysial junctures are still 

 open often take on a renewed growth during the pregnancy. And finally there 

 can be seen on it a relation to the growth of the fetus, if it be not forgotten that 

 the hyperplastic alterations in the anterior lobe of the hypophysis may also 

 produce and maintain the tendency to increased growth. 



When the cortical tumors develop in the fully developed organs the mani- 

 festations are quite different. Thus far the cases have been favorable. 

 Here there comes about a pronounced disturbance of the functions of the 

 sexual glands with involution of the uterus and in addition a tendency to 



