Malformation

They are seldom absent, but may be unusually small. Supplementary adrenals are not uncommon, and inclosure of fragments in the liver, kidney, and genital organs is quite frequent. They generally consist entirely of tissue of the cortical type. These may give rise to hypernephromata.

Fatty degeneration is quite common. The gland is yellowish and soft. The medullary portion mainly is involved, the cortex remaining as a thin wall. On account of postmortem changes taking place so rapidly, it is at times very difficult to accurately judge the importance of the lesion.

Amyloid changes occur in the blood-vessels as a part of general amyloid disease.

Pigmentation is present in senility. The cortex contains fine yellowish granules.

Hemorrhage sometimes occurs either as a result of injury or of constitutional conditions. The blood may be absorbed or encysted, with induration and calcification.

Syphilis occasionally occurs, either as a gumma or an induration.

Tuberculosis of the adrenals is not uncommon. It is frequently a part of a general miliary involvement.

Primary tuberculosis, in the form of a caseous degeneration, is the lesion most generally associated with Addison's disease. The adrenals are enlarged, nodular, and the capsule is thickened. Caseous areas and small cavities filled with a thick, curdy pus are frequently found. Calcification may take place.

Tumors

Sarcoma, adenoma, and carcinoma may occur as primary growths, and are not infrequently associated with Addison's disease. As secondary growths they are more common.

Addison's disease is a peculiar condition characterized by a deposit of pigment in the skin in the cells of the rete Mal-pighii, sometimes in the corium. "This discoloration pervades the whole surface of the body, but is commonly most strongly manifested on the face, neck, superior extremities, penis and scrotum, and in the flexures of the axilla, and around the navel. It may be said to present a dingy or smoky appearance, or various tints or shades of deep amber or chestnut brown".

The condition probably is due to disturbances of an atrophic nature within the chromaffin cells, either in the adrenal or in other portions of the sympathetic system. In those cases in which there is a destruction of the adrenals without the appearance of Addison's disease the chromaffin cells of the organ may be uninvolved or cells of a similar type elsewhere may have taken on a compensatory activity.

In the majority of cases there is tuberculosis of the adrenals. usually of both but sometimes unilateral. It may be primary, but generally is associated with tuberculosis of the lungs, genito-urinary tract or bones. Next in importance is an atrophy due to chronic interstitial connective-tissue formation with contraction. Carcinoma of the adrenals has been noted also in this disease.