The Surgical Management of Functional Adrenal Hypercorticism

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