Clinical Note

Understanding of the negative feedback relation between the adrenal and pituitary glands has important diagnostic and therapeutic applications. Normal adrenocortical function can be suppressed by injection of large doses of gluco-corticoids. For these tests a potent synthetic glucocorticoid, usually dexamethasone, is administered, and at a predetermined time later the natural steroids or their metabolites are measured in blood or urine. If the hypothalamo-pituitary-adrenal system is intact, production of cortisol is suppressed and its concentrations in blood is low. If on the other hand, cortisol concentrations remain high, an autonomous adrenal or ACTH-producing tumor may be present.

Another clinical application is treatment of the adrenogenital syndrome. As pointed out earlier, adrenal glands produce androgenic steroids by extension of the synthetic pathway for glucocor-ticoids (see Fig. 4). Defects in production of glucocorticoids, particularly in enzymes responsible for hydroxylation of carbons 21 or 11, may lead to increased production of adrenal andro-gens. Overproduction of androgens in female patients leads to masculinization, which is manifest, for example, by enlargement of the clitoris, increased muscular development, and growth of facial hair. Severe defects may lead to masculi-nization of the genitalia of female infants and in male babies produce the supermasculinized

40. Adrenal Glands

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