SYMPTOMS AND DIAGNOSIS. — The main symptoms of malignant growths are rapid loss of strength, debility, ema ciation, digestive disorders, and abdom inal pain, with skin-changes in some cases. These are fairly distinct in some cases; in others no symptoms point to a suprarenal origin. A differential diag nosis must be made from other suprar enal diseases, renal and hepatic tumors, diseased retroperitoneal glands, and cysts and growths of the pancreas. The prog nosis is always serious.
The symptoms of malignant neoplasm of the suprarenal gland in some respects suggests Addison's disease, but the re semblance is not marked, and the skin changes and disturbances of the eircula tory system are generally absent. Tuber culosis, the writer believes, with Leva, is more apt to involve the sympathetic; hence more apt to cause bronzing. The most frequent symptom (only 37 cases were available for study in this respect) was marked and progressive loss of strength—seen in 22 pUients—accom pulled in many by extreme languor and debility. Emaciation was present in 20. In 12 cases out of the 37 nausea and vomiting occurred; in 9 there was loss of appetite, diarrhcca in 4, and constipa tion in fi. The circulatory system was rarely involved. Though there was ex tension of the growth in the vena eava and thrombosis in 4 or 5 cases, they did not suffer from oedema. Pain existed in
25 cases; in some it was referred to the renal regions behind; in others it occu pied the whole back; in some it was in the epigastrium or hypochondrium. Three out of the 37 showed distinct bronzing of the skin; in 2 there was a peculiar profuse growth of hair. The temperature was usually normal, and not, as Berdach has claimed, subnormal. In 13 out of the 37 eases the growth caused no symptoms referable to the suprarenal. 0. Ramsay (Bull. Johns Hopkins Hosp., Jan., Feb., Mar., '99).
—Accord ing to Rolleston (Amer. Jour. Med. Sci., Oct., '98), the anatomical characters of malignant growths are often hoemor rhagic, with a tendency to break down in the centre and form a pseudocyst. Sar coma is the more frequent form, having been present in fifteen of twenty-four cases studied by him. Men are somewhat more frequently affected than women (Ramsay).
— Operative procedures proved successful in two of Ramsay's eases, the principal difficulties met with being the friability of the tumor, the great tendency to haemorrhage, and the frequency of adhesions. •