162 ENDOCRINE GLANDS 



They cause pressure pains: subhepatic pain, lumbar 

 pains, unilateral or girdle like, continuous or in paroxysms ; 

 gastro intestinal disturbances; vomiting, attacks of 

 diarrhea or obstinate constipation and quite often 

 respiratory difficulty. 



The evolution is usually very rapid. The patients 

 may die very suddenly. In the majority of cases they 

 lose weight, become cachectic and die in coma. Pigmen- 

 tation of the skin is not common. Sometimes death 

 occurs from extension of the tumor to the neighboring 

 organs or a generalization of the carcinoma. 



The diagnosis is very hard, for two reasons; for one, 

 these tumors have no definite symptomatology; the 

 other, that they are so rare that nobody suspects an 

 adrenal tumor. At first, because of the lumbar pain a 

 diaphragmatic, or subphrenic affection is suspected, or 

 even Pott's disease. The presence of ascites and of edema 

 of the lower limbs can hide the tumor and lead to suspect 

 a hepatic lesion. When a lumbar abdominal tumor is 

 distinctively made out it is often mistaken for a kidney 

 tumor, or if the digestive symptoms are prominent with 

 a neoplasm of the pylorus or colon. 



The only treatment is surgery. The removal of the 

 tumor is possible, but is dangerous. Survival is rare and 

 re-occurrence is the rule. 



GENITO-ADRENAL SYNDROME. 



To the study of tumors of the adrenals must be added 

 a special dystrophy described under the name of genito- 

 adrenal syndrome. 



In 1905 Bullock and Sequeira, then Guthrie in England 

 drew attention to the relationship which existed between 

 the adrenals and of the adipose tissue, genital organs and 

 hairs. In France, Guinon Apert presented successively 



