350 CLINICAL CONSIDERATIONS 



gone a violent change are commonly observed in patients 

 suffering from adrenal virilism. 95 • 303 - 655 



In many of the cases of adrenal virilism described in the 

 literature there has been a unilaterial tumor in one adrenal or 

 rarely at the site of a so-called adrenal rest. 363 In the large 

 series of Broster and Vines, 95 however, the affection was usually 

 bilateral. 



The treatment of the adreno-genital syndrome in adults does 

 not differ from that described in children in cases in which a 

 definite tumor has given rise to the condition. Successful 

 operations followed by retrogression of the abnormal signs of 

 masculinization have been recorded. 95303,655 In patients with 

 a bilateral affection of the androgenic tissue, the removal of one 

 gland with partial removal of the other must lead to an un- 

 satisfactory result, for the hypertrophy of the remaining andro- 

 genic tissue will eventually cause a reappearance of the original 

 symptoms. The logical treatment in such patients should 

 consist in the enucleation of the internal portions of the ad- 

 renals, thus removing the medulla and androgenic zones while 

 preserving the outer layer of the cortex which is essential for 

 life. Such an operation, performed in two stages to allow 

 regeneration of the cortical tissue left after the first operation, 

 would offer the best prospects for a permanent cure. 



A series of cases of adrenal virilism treated surgically with 

 considerable success has been reported by Broster and Vines 95 

 in London, and Kepler, Kennedy, Davis, Walters, and Wilder 655 

 at the Mayo Clinic. The 10 cases of Broster and Vines showed 

 no untoward signs following unilateral adrenalectomy. In 

 general there was a gratifying return of menstruation following 

 operation and some diminution in the degree of hypertrichiasis. 

 However, as already stated, Broster and Vines found no differ- 

 ence between the two adrenals, both showing the fuchsinophile 

 reaction by which they detected the androgenic tissue. Bros- 

 ter and Vines utilized the trans-thoracic route for their adrenal- 

 ectomy which they considered superior to the sub-diaphrag- 



