Suprarenal extract should be tried in all cases. There is little hope in cases of tuberculous origin; in those due to atrophy, sclerotic or inflammatory changes; but, if a portion of the gland is still active, the extract will probably be found beneficial. J. V. Shoemaker (Jour. Amer. Med. Assoc., Mar. 23, 1901).
Grainger Stewart, McCall Anderson, and other observers have reported cases treated with the suprarenal extract with out benefit.
Case of Addison's disease treated with suprarenal extract. Much improvement took place during the first four weeks, after which the failure was rapid until death occurred. Reference to 0 other eases recorded in which improvement had taken place in 5, in 2 no improvement, 1 died early, and 1 continued treatment but a few days. Sydney Ringer and A. Phear (Brit. Med. Jour., Jan. 18, '90).
Typical case in which the patient had been taking suprarenal capsule by the mouth for some time. The only appar ent effect was that the temperature, which had been subnormal, had returned to normal. T. R. Bradshaw (Lancet, Oct. 31, '90).
Administration of suprarenal extract in case of Addison's disease caused a dis turbance of nitrogen-equilibrium, leading to increased consumption of body-albu mins and to loss of weight. Max Pick ardt (Berliner klin. Woch., Aug. 15, '93).
Suprarenal capsules administered sub cutaneously to a ease of Addison's dis ease; within twenty-four hours patient died with subnormal temperature and great prostration and collapse. P. Cour mont (Quatrieme Congres Franc. de Med. Int., V).
Series of 43 cases of the disease col lected treated with suprarenal extract; of these, 13 were improved, 9 recovered, 11 died, 3 showed no improvement, and the result was not recorded in 7. W. W. Johnston (Amer. Med. Congress; Brit. Med. Jour., June 2, 1900).
Case of Addison's disease in a man of 40 in which suprarenal extract was given twice daily without effect, though it was not used till late in the course of the dis ease. Necropsy showed capsulated tuber culous deposits in the spinal column, lungs, and bronchial glands. The sub stance of both suprarenal bodies was re placed almost entirely by fibrous tissue. E. G. Trevithiek (Lancet, July 14, 1900).
Report of S cases, in 6 of which an attempt was made to treat the disease with suprarenal preparations. The re
sults obtained so far have been disap pointing, but do not warrant the giving up of all hope of some degree of ulti mate success. Most of the patients suf fering from this disease are already in the last stages when the diagnosis is made. C. R. Box (Practitioner, May, 1901).
Contradictory results having been ob tained ever since preparations of the suprarenal capsules were first used in the treatment of cases of Addison's disease, it is impossible to determine the real value of this treatment, it being well known that a considerable proportion of the cases continue a number of years, though they often show periods of im provement. And for the same reason it is not possible to determine whether the cases reported as cured will prove perma nent or only temporary. Moreover, if the clinical symptoms and conditions constituting Addison's disease result from the interruption of the functions of the suprarenal capsules, there must have been a prior pathological condition caus ing such interruption. And, while we might reasonably expect the use of su prarenal extract to relieve the pigmenta tion and asthenia so long as its use was continued, unless it also removed this primary pathological condition, the as thenia and pigmentation would sooner or later return, certainly after the discon tinuance of the remedy. The whole sub ject needs more careful and protracted investigation.
Removal of the diseased adrenal by surgical procedures is one of the latest means employed,—accidentally, it may be said, for the operation in the case reported had been performed for the removal of a malignant retroperitoneal growth that turned out to be a tuber culous suprarenal capsule.
Case of recovery after removal of a tuberculous adrenal lying directly on the spinal column and appearing as a small, movable, firm, nodular tumor. Pressure over it brought on a characteristic at tack of pain. The patient recovered in two weeks. All the symptoms disap peared after the operation. Eight months later no evidence of the disease could be discovered. Oestreich (Zeit. f. klin. Med., B. 31, p. 123, '97).