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. 6 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. 6 



Hyperplasia and tumor formation in the adrenal 

 cortex are associated with extraordinary changes in 

 the primary and secondary sex characteristics. In 

 1912, Ernest Glynn 9 exhaustively reviewed the whole 

 subject, adding five cases in children to those already 

 collected by Bulloch. 10 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- 



