Surgery of the adrenal gland.

The surgery of the adrenal gland is a subject which is expanding rapidly at the present time. Kendall's work on the identification of adrenal cortical hormones, leading in recent years to a plentiful supply of cortisone, has made such operations relatively safe. In addition, increased knowledge about the physiology of the gland has put this branch of surgery on a more rational basis. This article deals primarily with the surgical treatment of Cushing's syndrome and phaeochromocytoma, but a few introductory remarks are given on the physiology of the normal adrenal and in Fig. I will be found a simple plan of the disorders which may affect this organ and call for surgical correction. It must be stressed that treatment can only be carried out with any hope of success where there is close co-operation between physician, surgeon and biochemist, and they should share the preand post-operative management of the patient. The adrenal gland is composed of an outer yellow cortex and an inner reddish brown medulla. During foetal life the medulla arises from similar embryonic tissue to that which gives rise to the sympathetic nervous system and when fully developed this part of the adrenal gland elaborates two active hormones, adrenaline and nor-adrenaline. The medulla is not essential for the maintenance of life and similar tissue made up of chromaffin cells can be found in other sites. Tumours composed of such cells have been reported in relation to the abdominal aorta and occasionally in the neck and mediastinum. The cortex is essential to life and produces hormones controlling carbohydrate, protein and electrolyte metabolism. The cortex develops from tissue adjacent to that which forms the testis or ovary, and adrenal cortical dysfunction is often associated with changes in the sex organs of the individual. Total destruction of both adrenals leads to Addison's disease and death, but the patient can be kept alive by the administration of added salt in the diet and desoxycorticosterone acetate (DOCA), a synthetic cortical salt hormone. In addition cortisone may be given and leads to a greater sense of well-being and corrects any tendency to hypoglycaemia.