218 THE INTERNAL SECRETIONS—1920 
THE ADRENAL MEDULLA AND CORTEX 
The somewhat rare condition of osteomalacia is due, 
in part at least, to hyperfunction of the ovary, and 
castration affords the most prompt and permanent 
relief of any measure yet tried. Because several re- 
ports indicate that adrenalin has been successfully 
employed for the control of osteomalacia it may be rea- 
soned that in this disease there is some adrenal in- 
sufficiency. The adrenal medullary principle undoubt- 
edly is antagonistic to ovarian secretion. 
In cases of adrenal cortical hyperplasia amenorrhea 
is a constant phenomenon and in well-defined cases 
pregnancy never occurs. Amenorrhea is usually asso- 
ciated with Addison’s disease (apparently the symp- 
toms are chiefly due to insufficiency of the medullary 
secretion) ; but experimental evidence indicates that 
atrophy of the uterus, presumably with insufficiency 
of the function of the interstitial cells, occurs in these 
circumstances.°® 
Hyperplasia and tumor formation in the adrenal 
cortex are associated with extraordinary changes in 
the primary and secondary sex characteristics. In 
1912, Ernest Glynn’ exhaustively reviewed the whole 
subject, adding five cases in children to those already 
collected by Bulloch.1? Out of seventeen cases in chil- 
dren, fourteen were females. In these the uniform 
findings were a marked skeletal overgrowth, increase 
in the amount of hair on the face and pubes, and some- 
times an hypertrophy of the clitoris. Glynn also col- 
lected six cases occurring in young adult females, in 
all of whom there was growth of hair on the face, 
shrinkage of the breasts, amenorrhea, and sometimes 
a masculine voice. 
This pathological evidence is of value since it shows 
how closely the adrenal cortex, which is developed from 
the mesothelium of the Wolffian ridge adjacent to the 
germinal area, is connected with the sex character- 
