A Suggested Test for Functional Cortical Adrenal Tumor

A clinical syndrome characterized by facial and trunk obesity, hirsutism, pig eyes, either persistently high blood pressure or attacks of hypertension, amenorrhea or menstrual irregularity, pinkish skin striae, rarefaction in the bones, polycythemia, acrocyanosis of extremities and susceptibility to infection, has attracted increasing attention, particularly since Cushing described basophilic adenoma as a probable cause. 1 Previously a number of these cases had been found due to cortical adenoma or adrenal tumor. 2 It might readily be conceived, as suggested by Cushing, that a pituitary overfunction, perhaps limited to the basophilic type of cells, might secondarily produce cortical adrenal changes.

A typical case, diagnosed as “basophilic adenoma” was under my observation in my clinic and laboratory for 1 1/2 years during which time thorough hormonal studies were performed with extremely striking findings. This patient died suddenly (on the service of Dr. B. S. Oppenheimer) in consequence of an erysipelas secondary to an acute middle ear infection (unoperated), permitting a full autopsy. At autopsy the pituitary was found normal (serial sections, Dr. Joseph Globus), the basophilic elements proving diminished in number. A large carcinoma of the adrenal cortex was found. The case will be described in detail elsewhere. At the moment, the hormonal findings alone will be discussed.

Hormonal examination, extending over a period of 4 weeks, showed negative pregnancy tests, no increase in the prepituitary and female sex hormones circulating in the blood. 3 On the other hand, the excretion of female sex hormone in the urine was at times tremendously increased, to a degree seen normally only in pregnancy (13,000 Mouse Units per liter).