S DISEASE is most frequently C caused by idiopathic atrophy or by tuberculosis of the adrenal glands. At the Presbyterian Hospital in New York, of forty-six cases of Addison's disease studied at autopsy, twentyseven were due to primary adrenal atrophy and seventeen to tuberculosis. The remaining two cases are reported in this communication. Other causes of Addison's disease have been reported infrequently. Amyloid degeneration, syphilis, primary tumors of the adrenal cortices, hemorrhage caused by trauma, or vascular disease,5 coccidioidal granulomas,O and histoplasmosislo have all been responsible for adrenal destruction or insufficiency in rare instances.
Metastatic cancer in the adrenal glangs at necropsy is a common pathological finding. Indeed, Addison in his original descriptions attributed chronic adrenal insufficiency in certain patients to metastatic carcinoma. Data concerning these instances, however, do not allow retrospective confirmation. The first well-documented cases of Addison's disease resulting from adrenal destruction from metastatic carcinoma were reported in 1952 by Butterly and his collaborators and by Wallach and Scharfman. It seems probable that adrenal insufficiency secondary to metastatic cancer may become relatively more common because of the decrease in cases caused by tuberculosis and, in absolute numbers, more common because of the increase in deaths from malignant disease. Of pertinence to this is the rising incidence of bronchogenic carcinoma,B with its great propensity to metastasize to the adrenals. Glomset encountered metastases from bronchogenic carcinoma in the adrenal more frequently than in any other site with the exception of regional lymph nodes, lung, and bone.