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November 1959

The Surgical Management of Functional Adrenal Hypercorticism

Author Affiliations

Houston, Texas
From the Cora and Webb Mading Department of Surgery and the Departments of Medicine and Pharmacology, Baylor University College of Medicine.

AMA Arch Surg. 1959;79(5):791-798. doi:10.1001/archsurg.1959.04320110093015

The improvement of laboratory techniques for diagnosis of abnormal adrenal states has permitted the internist to present to the surgeon a greater variety of patients as possible candidates for treatment of overactivity of the adrenal cortex. The time-honored designation of "Cushing's syndrome" need not apply to this expanded group of patients since they may be considered to be in an earlier phase of "hyperadrenocorticism." Observations of a small group of these patients who have been subjected to total bilateral adrenalectomy constitute this report.

We believe that hyperadrenocorticism is initially a cyclical disease, which rarely is self-limited and most commonly is progressive. Further, if repeated observations are made on patients suspected clinically of having functional hypercorticism, the patients will persistently present these laboratory evidences (corticotropin-induced hyperresponsiveness), and the clinician is justified in recommending definitive therapy. In the absence of a chemotherapeutic agent to inhibit adrenocortical function (without prohibitive toxicity), one must