THE ADRENAL CORTEX:

Summary  This presentation has attempted to summarize the role of the adrenal cortex in health and disease. The medical conditions for which cortisone therapy has been employed have been listed, in order to alert the anaesthetist to the possibility of previous treatment with steroids m patients who are suffering or have suffered at any time from these diseases. The various tests for adrenal function are described, as are the treatment of adrenal cortical dysfunction, the complications of treatment, and contra-indications to steroid therapy The adrenals may be lemoved by the surgeon. (1) to influence secondary carcinoma; (2) to remove non-endocrine tumours of the adrenals, (3) to influence abnormal conditions of adrenal function manifested by hypersecretion of adrena] cortical hormones, (4) incidentally, in the course of operations on adjacent organs. In all these cases substitution therapy is necessary It should be started preoperatively and may have to be carried on indefinitely Finally, the condition of “latent adrenal insufficiency” is described. This is a syndrome characterized by a shock-like state following major stress It responds poorly to the usual measures adopted for shock, but is often dramatically influenced by the administration of large doses of adrenal cortical hormone Prophylactic use of steroid therapy in suspect cases is advocated