PATHOLOGICAL ANATOMY AND HISTOLOGY 273 



from time to time which indicate that disease of one endocrin gland may 

 involve other glands of the same type. Although the evidence is often 

 very striking the exact interpretation is still obscure. Probably the inter- 

 relationship of the suprarenals and the sexual glands have been demon- 

 strated most clearly. French investigators were the first to direct attention 

 to the influence of overfunction of the cortical portion of the suprarenal 

 upon the secondary sexual characters under the name syndrome genito- 

 surrenale. Bulloch and Sequeira(a) have collected a number of typical 

 examples, and, more recently Glynn has added others to Bulloch and 

 Sequeira's list and has carefully analyzed all reported cases to the date 

 of his publication. In children the result of these observations shows 

 that in females there is developed not only sexual precocity, e.g., menstru- 

 ation, development of external genital organs and breasts, but also the 

 development of male characters, notably hirsutes upon the face, axillae 

 and pubes. In males there is . also sexual precocity but male characters 

 are emphasized, the child's muscular development becomes abnormal, 

 showing the characters of an infant Hercules. In adult females, supra- 

 renal hypernephromata lead to the alteration of the secondary sexual 

 characters towards the male side. Menstruation ceases, the breasts 

 atrophy, extensive growth of hair develops upon the face, the voice fre- 

 quently changes, the muscular development may become marked and the 

 temperament becomes aggressively male in character. On the other hand, 

 there is very little evidence of the effect of suprarenal hypernephromata 

 upcn adult males. Finally, Glynn has shown that there is a close associa- 

 tion between cortical hyperplasia and female pseudo-hermaphroditism. 



An interesting relationship between suprarenal pathology and general 

 growth is seen in the condition described by Gilford as progeria and by 

 Variot and Pironneau as nanisme type senile. Three cases have been 

 described, two by Gilford and one by the French authors. In each case 

 growth ceased before the fifth year of life, the hair of the head, eyebrows, 

 eyelashes and trunk was almost entirely absent, the skin was dry and 

 wrinkled, the fat completely absent so that the muscles and tendons stood 

 out prominently, the genital organs were hypoplastic and at the end there 

 was extreme feebleness. In Gilford's case the autopsy showed fibrous 

 atrophy of the suprarenals. The French case showed fibrous changes not 

 only in the suprarenals but also in the spleen, lymph glands, pancreas, 

 thyroid and hypophysis. Although the authors relate the curious con- 

 dition to the suprarenal change, the observations are too few in number 

 and the histological studies too superficial to enable one to speak with 

 any positiveness in regard to their explanation. It is quite possible that 

 this senile type of nanism is a manifestation of pluriglandular disease 

 rather than simple involvement of the suprarenals. 



The influence of thyroid disease upon suprarenals must be marked, but 

 as yet no satisfactory morphological evidence of this has been secured. 



