150 ENDOCRINE GLANDS 



culous kidneys, by a fibrous fatty layer and transformed 

 in a fatty substance full of cavities containing pus or 

 caseated material, or they may be sclerosed and atrophic. 



These last two types are the most frequent. 



(d) Cold Abscess of the Adrenals. These are very rare. 

 The gland contains one or more pseudo cysts, with very 

 thin walls, containing a purulent fluid. 



Histological examination reveals tuberculous lesions 

 (real tubercles with giant cells, bunches of lymphocytes 

 containing tubercle bacilli). To these glandular lesions 

 are associated, more or less constantly, tuberculous lesions 

 of the sympathetic and the semi lunar ganglia. 



Sometimes the celiac and periaortic ganglia are swollen and 

 caseated and compress the solar ganglia and nerves which 

 become atrophic and disappear so that it is difficult to find 

 them, even by histological examination. 



2. SCLEROSIS OF THE ADRENALS. The origin of these 

 changes is very variable. An old infection (Sergent) a 

 lesion in the neighborhood, can be the cause. It may 

 also be the result of tuberculosis (Sezary). 



The adrenals are large and adherent to the liver, kidneys, 

 gall bladder and have a white color. They are made up 

 of a hard tissue, which cuts with difficulty. Histological 

 examination reveals many strands of connective tissue, 

 causing a separation and atrophy of the cortical cells and 

 sometimes even penetrating into the medulla. 



At the same time are noticed congestive lesions, infec- 

 tious nodules or cellular degenerations which show an 

 acute inflammation on top of old lesions. 



3. ADRENAL SYPHILIS. Very rarely syphilis is the cause 

 of lesions of the adrenals: gumma, diffuse sclerosis, etc. 



4. CARCINOMA. Primary or secondary cancer (epithe- 

 lioma, etc.) is rarely bilateral. For this reason, it is only 

 very rarely the cause of Addison's disease. 



