The unraveling of our knowledge of the functions of the adrenal gland
constitutes one exciting development of modern medicine and
biochemistry. We owe these advances to the felicitous cooperative
efforts of the clinical investigator and the biochemist. Three centuries
elapsed between the first recorded anatomical descrip- tion of the
adrenals and the demonstration by Dr. Addison in the mid-nineteenth
century of the fatal results of the destruction of these glands by
disease. It became evident from this observation that the adrenals
secreted a "factor" or "factors" essential to life. It took
approximately 90 years to isolate this elusive vital factor -
cortisone - from beef adrenal cortices, independently by both Reichstein
and his co-workers in Basle and Kendall and his group in the United
States and another 10-15 years before it became more generally available
for experimental and clinical use. It is perhaps difficult to believe
that as recently as 35-40 years ago, before cortisone and cortisol were
clinically available, the surgical removal of a benign adrenal cortical
tumor in patients with Cushing's syndrome was associated with a
prohibitive postoperative mortality rate. Within 12-36 h after
operation, most of such patients developed an intractable state of
shock, which was not manifested by significant electrolyte abnormalities
or hypoglycemia and was unresponsive to the usual treatment for shock
plus the generous use of salt-retaining hormone.