PART IV. CLINICAL CONSIDERATIONS 



The involvement of the adrenals in Addison's disease, in 

 adrenal tumors, and in certain anomalous developments of the 

 reproductive system has been well established. Aside from 

 these three conditions, which will be discussed in the following 

 chapters, the adrenals have been implicated in a number of 

 other clinical conditions on the basis of rather meager or ob- 

 viously fallacious evidence. It is, nevertheless, very probable 

 that the adrenals are involved in clinical conditions other than 

 those generally recognized at present. Heretofore, pathologi- 

 cal evidence and clinical observation have been the sole means 

 whereby one might hope to detect the association of adrenal 

 dysfunction with some clinical condition. Both of these 

 methods are, however, notoriously unsatisfactory. The his- 

 tological study of the adrenals is fraught (as we have seen in 

 Chapter III) with great difficulty and unless the greatest pre- 

 cautions are taken it is difficult to interpret the significance 

 of any observed abnormalities. Clinical observation is also 

 an unsatisfactory means of gauging adrenal function for the 

 symptoms associated with adrenal insufficiency are shared by 

 a number of diseases in which the adrenals are not involved. 



The development of potent extracts of the adrenal cortex 

 has opened a new field of investigation in the clinical study of 

 the adrenals. It is now possible by applying the therapeutic 

 test to determine if insufficiency of the adrenals is responsible 

 for a given clinical condition. 



Most of the earlier clinical literature on the adrenals was 

 based on the belief that epinephrine was the sole or at least 

 the important internal secretion of these glands. The litera- 

 ture, even of recent years, contains voluminous reports based 

 on this assumption. There is, however, no valid evidence to 

 indicate that an insufficiency of the adrenal medulla manifests 



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