318 BENSON A. COHOE 



in the suprarenals at autopsy in cases of uncomplicated superficial burns, 

 as due to a specific toxin originating in the burned area, rather than to 

 hemorrhagic infarction as formerly believed. Asphyxia, with the resulting 

 venous engorgement, is considered a common cause of hemorrhage in 

 the new born. 



There is no characteristic syndrome associated with suprarenal hemor- 

 rhage, whereby it may be differentiated clinically from other types of acute 

 suprarenal insufficiency. Sajous(a) has emphasized the point that supra- 

 renal hemorrhage is frequently preceded by a state of hyperactivity of the 

 gland, serving as a defensive mechanism, and resulting in a condition of 

 hyperadrenia. This hyperadrenia he regards as the cause of the hyper- 

 pyexia frequently observed in the course of the infectious diseases, preced- 

 ing suprarenal hemorrhage. In some cases of hemorrhage sudden death 

 may occur without premonitory symptoms. In the majority of cases, how- 

 ever, there is an abrupt onset with intense abdominal pain radiating to the 

 loins, vomiting, profuse diarrhea, tympanites, convulsions and collapse, 

 with death in from 6-48 hours. The condition is frequently mistaken for 

 that of acute hemorrhagic pancreatitis, which it closely resembles. In 

 children, hemorrhagic purpura, or petechial hemorrhages, are commonly 

 present. It is believed that not all cases of suprarenal hemorrhage termi- 

 nate fatally. Small hemorrhages may form hematoma and give rise to but 

 few symptoms of insufficiency, since the function of the gland is not ma- 

 terially affected (Sajous). 



Inflammatory changes in the suprarenals, as has been pointed out by 

 Lavenson, are rarely of the nature of a true epinephritis,* but are almost 

 always accompanied by hemorrhagic extravasation and necrosis, and fre- 

 quently with cavity formation. The causative factors of this condition 

 are mainly the same as those of suprarenal hemorrhage. Apart from in- 

 fections and intoxications, chronic lung and heart disease, i. e., diseases 

 tending to cause venous stasis, may produce inflammatoTy changes in the 

 glands. It is believed that healing may occur, when the inflammatory 

 process is of limited extent, with the formation of scar tissue. Primary 

 suppurative processes within the suprarenals have been described in a few 

 instances, 



Lavenson attempted a classification of the various types of acute 

 hypoadrenia, after an extensive study of case reports of this condition, 

 collected from the literature. He was able to differentiate five clinical 

 forms, on the basis of the preponderance of one or another group of symp- 

 toms: (1) Cases of sudden onset, with epigastric pain and tenderness, 

 and marked abdominal symptoms (vomiting, meteorism, and diarrhea 

 at times), followed by death within a few days the so-called "pseudo- 

 peritonitic" type of acute suprarenal insufficiency; (2) The asthenic type, 

 in which the essential feature is a profound asthenia, terminating within 



* The term "adrenalitis," often used, should be discarded as a hybrid. 



