Tumour of the Suprarenal Cortex in an Infant of 18 weeks.

REGINALD LIGHTWOOD, M.D., M.R.C.P., D.P.H. (From the Hospital for Sick Children, Great Ormond Street, London.) The functional importance of the suprarenal medulla was recognized for some years before that of the cortex was fully appreciated. While animals can live perfectly well without the medullary portion, total adrenalectomy causes death. From this and other data it is known that the cortex produces one or more hormones indispensable to life, and it would appear that the cortex is by far the more important element. The part played by these cortical hormones in the growth and maintenance of the genital system and of the secondary sexual characters has been a fertile field of study in which distinction has been won by physicians, pathologists, anatomists and physiologists alike. As early as 1806, F. Meckel', from studies in comparative anatomy, developed the idea of a relationship between the suprarenals and the sexual organs, his belief being that animals with prepotent sexual powers had large suprarenals. It does not appear that he recognized the separate importance of the suprarenal cortex. In 1816 Otto2 reported hypertrophy of the genital organs associated with hypertrophy oI' the adrenal. In 1905, there appeared a classical paper by W. Bulloch and J. H. Sequeira3, who described a case of a neoplasm of the suprarenal cortex in a female of eleven years, manifesting hirsuties with precocious growth and menstruation. Their suspicion that the simultaneous occurrence of the suprarenal tumour with precocity was no matter of chance was confirmed by a study of the literature. Going back to 1756 they were able to review twelve cases (all in children), and to originate the idea that hyper-function of the suprarenal cortex was the cause of the precocity in such cases. Though Bulloch and Sequeira pointed out that there are certain tumours of the suprarenal in young children not associated with evidence of precocious development, they did not recognize that these involved essentially the medullary portion. The work of R. Hutchison4, R. S. Frew5 and others has placed these cases in an entirely separate group, now known by such names as medullary hypernephroma, sympathetic neuroblastoma and neurocytoma sympatheticum. Among the effects of tumours of the cortex Bulloch and Sequeira gave excessive growth, hirsuties, precocious puberty, adiposity and muscular over-development. The youngest of their cases was 14 months old, and the oldest 14 years old. The average age of their series was 5 years, and only two were observed after the age of 7. This paper, which moulded physiological opinion regarding cortical function, has been followed by several notable contributions. In 1912, E. Glynn6 was able to add five more cases to the twelve already collected by Bulloch and