This is without doubt the most frequent and important of all the diseases affecting the adrenal bodies. We have here to deal with that special affinity which has so long been surmised to exit between Addison's disease and the scrofulous diathesis or habit of body. No morbid condition of the adrenals is so common as this, and the latest researches point, as has been already shown, to the fact that the char acteristic lesion of Addison's disease in the adrenal bodies is bacillary tuberculosis in varying degrees and stages.
Tuberculosis occurs in three forms.
1. Gray or miliary Deposits.—The adrenals may be wholly de stroyed by these. There may be no tubercular deposits elsewhere in the body, but most commonly there are others in the lungs, bron chial and mesenteric glands. Melasma is usually associated together with other symptoms of Addison's disease.
2. Larger Caseating Masses. —These may wholly, or almost wholly, replace the natural tissues of the glands. Translucent gray ish material may often be associated with caseous masses. In this condition, there are usually deposits of tubercle in the lungs.
3. Calcareous Concretions.—These May be hard, almost horny in consistence, and gritty, grating on section. This condition and the preceding are in fact characteristic of chronic tuberculosis in any organ, and especially of pulmonary tuberculosis. They may be re
garded as indicating adrenal phthisis, and tubercle bacilli are almost always to be recognized if carefully sought for. Adrenal tuberculosis may be, and often is, primary, but it is more often secondary to other deposits.
While constituting the special lesion of the adrenals in true Addi son's disease, it would appear that caseous masses may be deposited in the adrenals without the occurrence of the ordinary symptoms of that malady. Thus Dr. Pye-Smith has given me notes of a recent case of pulmonary and laryngeal plithisis, with alcoholic cirrhosis of the liver and ascites, in which in one adrenal body there was an opaque caseous mass the size of two peas, and in the other body two smaller similar masses. The natural tissue was pushed aside, but not otherwise affected. There was no softening or contraction, and no thickening of the surrounding connective tissue. During life there were no symptoms of Addison's disease.
As has been already pointed out, chronicity of the tubercular pro cess is an important factor in determining most of the characteristic symptoms, and the condition of fibrosis with entangling adhesions to adjacent parts appears further to be a very constant requirement for their due development in any case.