CARBOHYDRATE METABOLISM 203 



EFFECTS OF THE CORTICAL HORMONE 



The claim of earlier workers that the adrenal cortical hor- 

 mone causes a rise in the blood sugar of normal animals has 

 not been confirmed by subsequent workers. 267 Hypergly- 

 cemia is caused by a number of substances and the presence of 

 impurities in the extracts accounts most likely for the earlier 

 results. Silvette's 569 claims of an in vitro effect of the cortical 

 hormone on the blood sugar are not borne out by an examina- 

 tion of the probable errors of his observations as calculated 

 from his data. 



There is ample evidence accumulated by numerous authors 

 since 1908 that adrenal cortical insufficiency is accompanied 

 by abnormalities in the carbohydrate metabolism. The claim, 

 however, that this breakdown in normal carbohydrate metab- 

 olism constitutes "the first critical contingency in adrenal 

 insufficiency" or is the pre-eminently "potent" factor in 

 adrenal insufficiency, as claimed by Britton and his co-work- 

 ers, 89 is untenable. Many animals (dogs in particular) may 

 show marked symptoms of adrenal insufficiency without an 

 appreciable hypoglycemia or reduction in the glycogen stores 

 of the body below their normal fasting levels. 



It is very true that in a few cases (both in experimental 

 animals and in man) hyperglycemia is a predominant symp- 

 tom of adrenal insufficiency. 17 - 473 In animals, particularly 

 those which have been subjected to a chronic insufficiency of 

 several months duration, the convulsions characteristic of 

 hypoglycemia may develop and are relieved by an injection 

 of glucose. In the vast majority of cases, however, this is not 

 the case and injection of glucose does not cause any striking 

 alleviation of the symptoms of insufficiency. As Banting and 

 Gairns, 31 Stewart and Rogoff, 588 and others have shown, the 

 hypoglycemia of dogs may be only a terminal finding and 

 hence not to be seriously considered as involved in the primary 

 manifestations of adrenal insufficiency. Moreover, the blood 

 sugar of dogs dying of adrenal insufficiency may often be 



