4'28 I'RIST, MACDONALD, MOSS, AND SKOOG 



phate, whereas patients with osteoporosis had 80 to 100 per cent. 

 Goldsmith et al. ( 1962 ) employed an infusion of 180 mg of calcium 

 in the form of calcium glucoheptonate and observed that phosphate 

 excretion was unchanged in hyperparathyroidism, but lowered in 

 other bone conditions. Frost ( 1961 ) measured the number of How- 

 ship's lacunae per unit yolume of bone in undecalcified thin ground 

 sections of cortical biopsies of 12 cases of osteoporosis, and con- 

 cluded that osteoclasis was four times greater than in normal sub- 

 jects. Though bone biopsies and tests of intestinal tract and kidnev 

 excretion of calcium and phosphate were extremely yaluable, it 

 was not possible to diagnose low-grade hyperparathyroidism with- 

 out an exploration of the neck and a positive identification of en- 

 larged parathyroid glands (Henneman et ah, 1958). 



Adrenal Cortical Hormones 



and Intermediari/ Metabolism of Protein 



Postmenopausal or senile osteoporosis is radiographically and 

 histologically indistinguishable from osteoporosis associated with 

 Cushing's syndrome, either the endogenous or the exogenous form 

 (Murray, 1961). The mechanism of depletion of the bone tissue by 

 the action of glucocorticoid hormones has been attributed to inhi- 

 l:)ition of formation of osteoblasts with relatively little effect on the 

 normal bone-resorbing activity of osteoclasts. Suppression of bone 

 formation alone explains the decrease in absorption of calcium from 

 the intestinal tract that is generally found in Cushing's syndrome, 

 but direct effects have also been reported by Bhandarkar et al. 

 (1961). Children and women after the menopause were more sus- 

 ceptible than men to bone destruction by cortisone (Schlesinger 

 et al., 1961). Anabolic steroids protected, but vitamin D increased, 

 the vulnerability of the skeleton (Bassett et al., 1960). 



One of the intriguing aspects of the mineral metabolism was the 

 effect of adrenalectomy. Patients with endogenous Cushing's syn- 

 drome were relieved of a backache and further fractures of the 

 spine, vet the radiographic picture was relatively unchanged follow- 

 ing this operation (Martinez and Greenblatt, 1962). Myers (1962) 

 reviewed the literature on calcium metabolism in adrenalectomized 

 animals, including patients with Addison's disease, and concluded 



