THE PATHOLOGY OF THE ADRENAL GLAND IN ADDISON’S DISEASE WITH SPECIAL REFERENCE TO ADRENOCORTICAL CONTRACTION

Abstract

21 patients with adrenocortical contraction and specimens from 31 patients with Addison''s disease caused by tuberculosis were accessioned. The clinical syndrome was in many instances so atyplcal and confusing that the diagnosis of adrenal insufficiency was not entertained, particularly when the disease ran a short, fulminating course. Acute gastro-enteritis, poisoning, ruptured peptic ulcer, coronary occlusion, psychosis, intracranial hemorrhage and myasthenia gravis were all simulated. The danger of temporizing with the medical emergency of adrenal insufficiency was underlined by the repeated occurrence of sudden collapse and death. The morphologic plcture in 21 cases of adrenocortical contraction ranged from that of pure destructive atrophy, or collapse of the cortex to that in which the regeneration of cortical cells and nodules in atyplcal patterns overshadowed and masked the underlying atrophy. Although the early stage of "atrophy" is rarely encountered in material obtained at autopsy, the Institute files contain 4 examples of cortical degeneration, necrosis and inflammation so pronounced that they could be considered the hypothetical precursors of, adrenocortical contraction. The lesions in adrenocortical contraction differ strikingly from those caused by vascular occlusion, syphilis, and tuberculosis. They bear a strong resemblance to the lesions of necrotizing hepatic injury and its sequelae.