Functional zonation of the human adrenal cortex with special reference to hyperadrenocorticism and aging process, and its significance in pathology.
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Various conditions of the adrenal gland are amenable to surgical treatment. Removal of a pheochromocytoma is almost always indicated when the tumor is diagnosed. The results of extirpation have been excellent in cases in which patients were operated upon before the onset of chronic hypertension. Removal of the "nerve cell" tumors of the adrenal is indicated if metastasis cannot be demonstrated. Hypofunction of the adrenal cortex may be partially alleviated by the repeated implantation of pellets of desoxycorticosterone acetate. Hyperfunction of the adrenal cortex causes a variety of clinical manifestations depending upon which of the numerous hormones are affected. Removal of a cortical tumor alleviates these symptoms. These tumors are malignant in more than 50 per cent of cases, and recurrence is frequent. Bilateral hyperplasia of the glands rather than a tumor may be present. In such circumstances, resection of 95 per cent of the adrenal tissue is effective in controlling the symptoms of the disease. Total bilateral excision of the adrenals is, at present, under investigation as a means of treatment for a variety of conditions.
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In a boy suffering from adrenoleukodystrophy (ALD) the function of the adrenal cortex and pituitary gland was followed prospectively. At the onset of the disease an autonomic hyperfunction of the adrenal cortex was shown. Subsequently the secretion of cortisol dropped to low levels despite high plasma levels of ACTH. The results suggest a primary disorder of the adrenal cortex in ALD, which up till now could only be postulated on anatomical evidence. With the use of computerized tomography and electroencephalography abnormalities characteristic for ALD were shown. The progression of the disease was followed using these noninvasive methods of examination.
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