280 CORTEX 



improbable that this procedure entirely prevents the secretion 

 of any epinephrine from the denervated gland. 



SURGERY OF THE HUMAN ADRENAL 



Surgical operations on the human adrenal have involved 

 chiefly the removal of the glands for tumors. Denervation of 

 the glands or their resection for hypertension or hyperthy- 

 roidism are based on such ill-defined grounds that they need 

 not be considered here. 136 * 



Surgery of the adrenal has in the past been attended with an 

 exceedingly high mortality. This is to be attributed probably 

 to the acute cortical insufficiency which the patients suffer 

 as a result of the combined effects of the trauma, anesthetic, 

 reduction in the amount of active cortical tissue, and injury 

 of the remaining gland by manipulation. The administration 

 of large doses of the cortical hormone following the operation 

 should offer a means of maintaining the patient in good condi- 

 tion until the residual cortical tissue has hypertrophied. 



In the surgical approach to the adrenals in man either a 

 lateral, posterior lumbar incision, or a transverse, abdominal 

 incision half-way between the ensiform cartilage and umbilicus 

 are most commonly employed. The former approach is 

 similar to that used in operations on the kidney and avoids 

 opening the peritoneal cavity. The second approach has the 

 important advantage that it permits examination of the two 

 glands. This is often of vital importance. An enlarged gland, 

 assumed to be a tumor, has been removed with fatal outcome. 

 Post-mortem examination proved the extirpated gland to be an 

 hypertrophied gland while the other gland was atrophied. 

 An abdominal approach also permits examination of the ovary 

 for suspected tumors. 95 - 655 



Crile 655 has emphasized the danger of handling the glands, 

 the delicacy of which we have already discussed in Chapter 

 III. Handling may cause a fatal apoplexy of the adrenals 

 and Crile therefore recommends that the examination of each 



* Cf. Jour. Am. Med. Assoc, vol. 106, p. 279. 



