EXCRETION OF GLYCOGENIC CORTICOIDS AND OF 17-KETOSTEROIDS IN VARIOUS ENDOCRINE AND OTHER DISORDERS

THERE have been a number of methods of estimating the function of the adrenal cortex in clinical disorders. First has been the observation of clinical symptoms and signs and the grouping of these into the classical syndromes associated with gross diseases of the adrenal cortex. Difficulties have arisen in that many cases do not possess all the features of the well established disease and terms such as Addisonism and hypoadrenalism have been coined to describe those clinical states in which the evidence for hypofunction of the adrenal cortex is often largely inferential. On the hyperfunctional side the association of virilism with hyperplasia and tumors of the adrenal cortex has resulted in the tendency to attribute all cases of simple hirsutism to hyperfunction of this gland. Second, the observation at autopsy or at operation of gross and microscopic morphological changes in the gland has been used. It was by this method that the classical syndromes were established. The method cannot of itself, however, detect changes in function which may occur without gross morphological change and the observation in clinical cases is usually a single one often made after the death of the patient. Also the association of changes in lipid content directly with functional change cannot be done on morphological grounds alone; for example, a depletion of the lipids of the gland does not necessarily indicate functional exhaustion.