204 CORTEX 



normal or even slightly above normal. It is thus unjustifiable 

 to lay too much stress on the relation of the adrenal cortex to 

 carbohydrate metabolism. We must consider the observed 

 changes in the carbohydrate metabolism as only one of the 

 many abnormalities associated with cortical insufficiency. 



The exact mechanism responsible for the changes in the 

 carbohydrate metabolism observed in adrenal insufficiency are 

 still unknown. Part of the deficiency may be due to the star- 

 vation which results from the anorexia of adrenal insufficiency. 

 The chief factor is most probably the inability of the liver and 

 muscles to function properly without an adequate supply of 

 the cortical hormone. The synthesis of glycogen in the liver 

 and muscles may be deficient in the absence of this vital hor- 

 mone. The exact role which other glands — the pancreas, pitui- 

 tary, etc. — play is also unknown. Pancreatectomy does not pre- 

 vent the usual fatal outcome or mitigate the symptoms of cortical 

 insufficiency. 402 Further work is indicated before we can 

 authoritatively discuss the exact nature of the relationship 

 between the adrenal cortex and carbohydrate metabolism. 



