The adrenal glands are orange-colored endocrine glands which are located on the top of both kidneys. The adrenal glands are triangular shaped and measure about one-half inch in height and 3 inches in length. Each gland consists of a medulla (the center of the gland) which is surrounded by the cortex. The medulla is responsible for producing epinephrine and norepinephrine (adrenaline). The adrenal cortex produces other hormones necessary for fluid and electrolyte (salt) balance in the body such as cortisone and aldosterone. The adrenal cortex also makes sex hormones but this only becomes important if overproduction is present.

Indications for Surgical Removal of Adrenal Glands

The indications for surgical removal of the adrenal gland are relatively straightforward and include, but are not limited to the following:

• Tumors of the adrenal cortex which overproduce hormones. One such tumor is shown in the picture...it is the round yellow mass located within the triangular adrenal gland. This picture is blown up about 2-fold to make it easier to see. The normal adrenal gland is NOT this big. Endocrine glands are very important despite their small size since they make important hormones.
  
• Tumors of the adrenal medulla which overproduce adrenaline (pheochromocytoma).
  
• Most solid tumors of the adrenal gland which are greater than 4 cm (~2 inches) regardless of whether they produce hormone or not (to rule out malignancy).
  
• Primary cancers of the adrenal.
  
• Any size adrenal mass which causes symptoms such as flank pain or tenderness

This condition is also more properly known as congenital adrenal hyperplasia. This is a group of conditions of similar source: a family of autosomal recessive disorders of steroid hormone production in the adrenal glands leading to a deficiency of cortisol, the stress fighting hormone. The master hormonal regulatory gland, the pituitary, sensing the deficiency, secretes massive amounts of the stimulating hormone corticotropin to bring the cortisol levels up to normal. This hormone in turn causes the adrenal glands to overproduce certain intermediary hormones which have testosterone-like effects on the fetus and child, leading to so-called "virilization."

Virilization means that the clitoris of girls is enlarged, and may resemble the male penis to the point that the sex of the child is questioned or mistaken. Males have enlarged penile size. Virilized children grow abnormally rapidly because of accelerated bone maturation and go through puberty very early but ultimately wind up being quite short as adults. See bone age test.

All of the forms of congenital adrenal hyperplasia are caused by genetically induced enzyme deficiencies in the pathways that produce steroid hormones. Deficiency of the enzyme 21-hydroxylase accounts for 95% of affected patients.

About 75% of affected infants have the "salt-losing" form of the disorder, in which the salt-retaining steroid hormone is deficient . This is potentially fatal if undiagnosed. Lacking this hormone, the baby can progressively lose body salt and go into shock. For this reason, newborn screening programs, using heelstick blood have been developed to detect 21-hydroxylase deficiency. They are required in most states.

Treatment of this condition involves hormone replacement. Treatment is monitored by measures of blood salt composition (electrolytes), by suppression of overly-rapid sexual maturation, and by monitoring of the skeletal maturation rate by bone age testing.

Addison's disease is an endocrine or hormonal disorder that occurs in all age groups and afflicts men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and nonexposed parts of the body.

Addison's disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone. The disease is also called adrenal insufficiency, or hypocortisolism.

Cortisol

Cortisol is normally produced by the adrenal glands, located just above the kidneys. It belongs to a class of hormones called glucocorticoids, which affect almost every organ and tissue in the body. Scientists think that cortisol has possibly hundreds of effects in the body. Cortisol's most important job is to help the body respond to stress. Among its other vital tasks, cortisol

• helps maintain blood pressure and cardiovascular function
• helps slow the immune system's inflammatory response
• helps balance the effects of insulin in breaking down sugar for energy
• helps regulate the metabolism of proteins, carbohydrates, and fats
• helps maintain proper arousal and sense of well-being

Because cortisol is so vital to health, the amount of cortisol produced by the adrenals is precisely balanced. Like many other hormones, cortisol is regulated by the brain's hypothalamus and the pituitary gland, a bean-sized organ at the base of the brain. First, the hypothalamus sends "releasing hormones" to the pituitary gland. The pituitary responds by secreting hormones that regulate growth and thyroid and adrenal function, and sex hormones such as estrogen and testosterone. One of the pituitary's main functions is to secrete ACTH (adrenocorticotropin), a hormone that stimulates the adrenal glands. When the adrenals receive the pituitary's signal in the form of ACTH, they respond by producing cortisol. Completing the cycle, cortisol then signals the pituitary to lower secretion of ACTH.

Aldosterone

Aldosterone belongs to a class of hormones called mineralocorticoids, also produced by the adrenal glands. It helps maintain blood pressure and water and salt balance in the body by helping the kidney retain sodium and excrete potassium. When aldosterone production falls too low, the kidneys are not able to regulate salt and water balance, causing blood volume and blood pressure to drop.

"Acupuncture" may be more appropriately called Traditional Oriental Medicine.At the heart of it is the concept is that there is Qi (aka: Ki, Chi), a physical "energy force" that exists in every part of the living world. The flow of Qi in the channels of humans is familiar to anyone has seen the lines on the body of an acupuncture chart or model. Most practitioners believe that these Qi meridians exist as a separate system although sometimes in conjunction with the nerve and blood systems. These Channels of energy are named after the body's organs but do so only to describe a system of how one portion of the body works. For example, the liver in oriental medicine is described not as a physical organ as much as its role in moving Qi throughout the body.

Acupuncture, as it is known in the United States, is actually a mixture of herbology, acupuncture and other healing arts. A practitioner may or may not use needles, herbs, magnets, crystals or his or her own Qi. Each of these modalities has its own rich tradition and it is not necessary for a practitioner to use all of them.

Acupuncture itself is the placing of very thin stainless steel needles into appropriate points around the body. The needle may go from 1/5 of an inch to 3 inches into the body depending on the treatment and the part of the body. We cannot say that this is always painless but it is certainly less than the hypodermic syringes we are all afraid of. Any pain usually dissipates within a few seconds. In its place may be a distending or slight heat sensation. The needles may go in the abdomen, arms or legs, head or in the ears. There are two notable recent offshoots of traditional acupuncture. Ear acupuncture says that all the organ functions can be seen in the ear. Even smaller needles are precisely placed in different sections of the ear for treatment. Scalp acupuncture is used extensively in China and elsewhere for the treatment of stroke and other cerebral originating diseases. The needles are inserted horizontally (not into the brain!) and often vibrated to affect the different lobes of the brain.

What can I expect from my practitioner ?
Oriental Medicine is the dominant form of medicine for much of the world's population and has been so for thousands of years. To paraphrase Mark Seem (acupuncturist and writer), each patient seeks treatment on three levels. The first is for aches and pains, the second for systematic problems of the organs and the third for the deeper issues of life and existence. Oriental Medicine can address each of these and your practitioner may choose to treat you in any one, two or all of these levels. To generalise greatly: acupuncture is very good at pain, herbs at system "re-structuring", while the deeper issues are best dealt with a combination of acupuncture, herbs and a skilful practitioner. Many people may be surprised that Oriental Medicine does indeed have a psychology. It posits that the functioning of the Qi on the organs can influence emotions, moods and personality and vice versa.

How long does it take get better ?
In the past practitioners got paid when they kept their patients well, not when they got sick. In general we say that treatment for chronic illness takes one month for every year that one is ill. Oriental Medicine is superior at preventative medicine. Acute diseases should see results in 3 or 4 treatments. In mainland China, patients are routinely given 10 acupuncture treatments and then they are re-assessed. After they have been cured of their original complaints, many people come back periodically for "tune-ups". For this type of person, Oriental Medicine means a life-long commitment to keeping one's body and mind in balance.

Let it be emphasised that if you have an acute life-threatening situation you should seek the help of Western Medicine. Oriental Medicine is capable of treating many serious diseases but it does have limitations. If your life is on the line take advantage of what Western Medicine has to offer. X-rays, ultra sounds and blood tests have no parallel in Oriental Medicine. If you decide for surgery or radiation therapy continue to see a good Oriental Medicine practitioner. He or she can help to ameliorate side effects and to help re-build your energy.

What is the modality of your practitioner ?
It used to be that one could only learn Oriental Medicine by being born into a family of practitioners or by sweeping the floors of the "masters" clinic. Now Oriental Medicine Schools in the West have allowed many of us to practice who otherwise would not have the chance. Some of the best practitioners in the world are now in the West, spreading the traditions of their home countries. For example, acupuncture has a long history in France through the colonisation of Vietnam. In a sense, all of Oriental modalities in the West are regional traditions which now have a chance to intermingle. It is perhaps a conceit that many Western practitioners feel that acupuncture will best thrive and grow outside the constraints and historical bondage of their home countries.

Traditional Chinese Medicine
Many of the schools in the United States follow Traditional Chinese Medicine (TCM), a compilation of many Chinese traditions formed by Mao in 1956. TCM tries to reconcile the two separate branches of acupuncture and herbology in China. Western Medicine has been well entrenched in China since the turn of the century and TCM is very much aware of Western science. Although the TCM system has its limitations, it is a complete system that perhaps has the best chance of interfacing with Western Medicine.

Traditional Chinese Medicine comprises Herbal Medicine, Acupuncture and TuiNa Clinical Massage. It treats the broad range of human illnesses from acute to chronic, holistically, acknowledging both your constitution and the nature of your illness. You can also receive Chinese Medicine simply to maintain good health. Diagnosis according to Chinese Medicine Patterns is done by observation, explorative questions and skilfully examining your pulse and tongue. After diagnosis your practitioner methodically plans your treatment by Herbs, Acupuncture, TuiNa or a combination of these, and gives you appropriate advice on self-help including diet and exercise to restore or maintain your health.

Worsley School and "5 -elements"This intriguing modality was developed in England. It is almost "homeopathic" in its approach. Patients are interviewed extensively to discover their Causative Factor (CF), the most earliest and deepest mental or physical trauma from which all other diseases spring. Patients do not take herbs and are discouraged from other modalities while undergoing treatment. Emphasis is placed on the patient taking responsibility for their own illnesses.

Why is there so little research into Oriental Medicine and acupuncture ?
More than anything Oriental Medicine is a clinical science. There are thousands and thousands of books written about Chinese Medicine. There are books about theory, herbology, acupuncture and case studies. Unfortunately for us, these books are written in Chinese and other Asian languages. There are other reasons why Oriental Medicine has yet to be accepted as a (Western) science.

In Asia it is considered immoral to withhold a treatment from a patient if it is believed it will help. For that reason there are few "control-group" studies in the 2000 years of Oriental medicine. The control-group is a mainstay of western scientific proof. Oriental diagnosis does not neatly translate into western diagnosis. A disease category such as asthma has a dozen or more causes in Oriental Medicine. "Asthma" could be from Cold Excess, Heat Excess, Heat Deficiency, Excess Above-Deficiency Below, etc... Each of these has a completely different treatment strategy and uses different herb formulas and acupuncture points. The medicine itself demands that the treatment is modified according to each patient. In addition, the acupuncture or herbs change with the progression of the disease or cure. It would be bad medicine to prescribe the same herbs over a series of treatments when the patients conditions change. The constituents of the herbs are so complex that it will take years to analyse them. Most herb formulas use from 1-20 different herbs. These are used in differing amounts according to the signs and symptoms of the patient at that time. (Formula writing is the real art and science of the superior Oriental doctor.) A single raw herb used in a formula may contain a dozen or more chemical constituents

Acne is a condition in which inflammation and infection of the sebaceous (oil) glands and ducts result in pimples, pustules and cysts on the skin surface.

Causes
The underlying cause of acne, which to one degree or another affects approximately 80 percent of all teenagers, is the glandular revoluion that takes place with the onset of puberty. At this time, the pituitary governor of glandular activity alters the proportion of the male sex hormone androgen and the female sex hormone estrogen so that sexual maturation can be accomplished. Between puberty and maturity, both boys and girls have a consistenly high level of androgen. This temporary increase in the androgenlevel stimulates the production of the sebaceous glands which ordinarily discharge the fluid secretion sebum through the pores for lubricating the skin. Overproduction of sebum causes it to turn into a paste which backs up and plugs up the ducs extending from the glands in the underlying derma through the layers of the epidemis.

Symtoms
Since the skin pores are tiny and often clogged by dirt or cosmetics, the fatty sebum accumulates under the skin and form a pimple, a whitehead or a blackhead. These manifestations of acne are most numerous particulary around the nose, the cheeks and the shoulders. The dark color of the characteristic blackhead is not the result of dirt, but of the discoloring effect of air on the fatty subtance in the clogged pore. Bacteria on the skin surface may eat their way through the pasty accumulation into the ducts and the derma itself causing not only pimples in which pus gathers but, in severe cases, cysts that damage underlying tissue.

Treatment
In a majoring of cases, acne is a transitory condition that gradually diminishes with the stabilization of hormones in adulthood. In its mild form, it can usually be controlled by a rigorous routine of cleanliness and the avoidance of rich desserts, fried foods and cola beverages. Cremas and cosmetics that further clog the pores should be eliminated in favor of medicated soap and hot water. Sun lamp treatments and medications containing vitamin A may be used under a doctor’s supervision. Pimples should not be “squeezed” since this method of eliminating pus can lead to more serious infection.

Severe cases of acne that leave the skin pitted and scarred require professional attention. The technique of dermabrasion, in which high-speed rotary wire brushes remove the outer layer of damaged skin, produces satisfactory results in many instances. It should not be undertaken unless a qualified dermatological specialist has benn consulted.

Adolescents are especially sensitive about their apperance and should not be teased about their pimples. A youngster whose emotional well-being is seriously threatened by skin problems may require a few sessions with a sympathetics psycoterapist for the necessary reassurances that acne in most cases is only a temporary condition.

A disorder in diabetic women characterized by development of excessive hair on the face and chin. The condition is also called virilism. Women with this syndrome often have changes of the voice and menstrual difficulties. Their breasts get smaller, they gain weight, and the clitories enlarges.

Achard-Thiers syndrome may be associated with enlargement of the adrenal glands and with excess androgenic (male) hormones in the bloodstream. In drastic cases, surgical removel of adrenal glands may be required; the woman must then, however, take for life the hormones normally manufactured by the adrenal cortex, as these are essential to life.

A dull, constant, sometimes throbbing pain. A backahe often is described as a dull pain, and a toothache or headache as a throbbing pain. A dull aching pain of the bones occurs in influenza, and muscular rheumatism involves aching of the muscles.

An ache, like all other types of pain, is useful and even life-saving. It is a warning signal, indicating that something is wrong. Without the ache of a strained back, a decayed tooth, a bruised muscle, or ab inflamed joint, a personwould not know that something was wrong until much more damage had been done.

How quickly a person feels pain and how much he or she can tolerate is both physiological and psychological. The pain hreshold is a measure of the stimulus needed in order to register pain. The ability to sustain pain without complaining, crying, or inability to work varies greatly from person to person. An individul’s reaction to aching pain depends on many factors, including his previous experience with aches, his chilhood training with regard to appropriate responses to aches, his general state of health, and the presence or absence of fatigue. If someone is busy with work or play, an ache may hardly be noticed.

Aching-possibly caused by the build up of toxic substances often follows strenuous exercise. The ahiness gradually disappears with rest. The same aching feeling accompanies many illnesses, including a severe cold and malfunctioning kidneys. In such illnesses, the accumulation of wastes in the system produce the symptom of generalized aching until the illness disappears or is successfully treated.

Organs which are related to the reproductive organs. In the male, the accessory sex organs include the apididymis, a portion of the seminal duct along the posterior border of the testis. Mature male sperm cells are stored here. The prostate gland, at the neck of the bladder, manufactures secretions that help transport the spermatozoa. In the female, the accessory sex organs include the vulva, two pairs of lip-shaped skin and soft membranes that surround the opening of the vagina, and the clitoris, a small projection of soft skin where the inner pair of vulva meet at the top.

A localized pocket of pus in a cavity formed by tissues that have broken down as the result of infection or injury. The inflamed area forming the cavity is red, painful, and swollen. An abscess is caused when bacteria enter a small wound, such as that caused by a splinter.

White blood cells collect at the infected area to seal of the infection, to absorb the bacteria, and to liquefy them. The formation of thick yellowish pus result from this activity. The accumulating pus and the swelling of inflamed tissues press against the nerves, creating pain. The redness is caused by a concentration of blood in the area. An abscess “comes to a head” as the wall of surrounding tissue becomes thin. When the abscess ruptures and the pus escapes, the pain and swelling subside.

A large, extremely painful abscess, such as a boil, should be professionally treated. A physician will open abscess saaafely with a sterilized instrument and remove the pus without unnecessarily irritating the tissue. Even a small skin abscess should not be squeezed, since this is likely to spread the infection.

An abscess may form within the body as well as on the skin surface. They can occur, for example, in the chest, abdominal cavity, joints, glands, or at the root of a tooth. Sometimes, a doctor may have to cut into and drain an abscess to prevent its sac of infection from spreading into surrounding tissues or escaping into the bloodstream. If an abdominal abscess ruptures, the resulting general infection (called peritonitis) requires immediate emergency care. A widespread body infection, or sepsis, results from the emptying of an abscess in the bloodstream

Often follow the interruption of a pregnancy by someone other than a physician. When induced abortions were almost always illegal and many women resorted to unlicensed persons, some of whom used crude techniques in unsanitary settings, abortion complications were frequent, and often fatal. Careless and ignorant methods can perforate the uterus and cause hemorrhage. Infection, kidney failure and shock are often associated with criminal abortion.

If the uterus is puctured, abdominal surgery may be required to save the woman’s life. Severe and protracted infection can cause the kidneys to stop functioning or to function imperfectly. In this situation, special dalysis equipment must be used to restore kidney function and prevent blood poisoning.

The chances of complications resulting from induced abortion are sharply reduced if the procedure is performed in a hospital or clinic by a licensed physician.

A muscle that draws a part away (abducts) from the body or an extremity. An abductor muscle may be tiny ( as in the fingers and toes ) or large and powerful ( as the thighs ).

The principal abducor muscles include the abductor digiti minimi (which abducts the little finger in the hand and the little toe in the foot); the abductor hallucis (which abducts and extends the thumb); the deltoideus (which abducts, flexes, and extends the arm); the gluteus maximus or buttock (which extends, abducts, and rotates the thigh outward); the extensor carpiradialis longus (which extend and abduct the wrist joint); and the interossei dorsales (which abduct and flex the toes).

An adductor muscle is one that draws a part toward the body.

The partion of the body between the lower part of the chest and the pelvis. This oval-shaped cavity is separated from the chest by the diaphragm. Heavy muscles protect the abdomen in the fron and sides, and the spinal column with its muscles protects it in back.

The abdoment is lined by a membrane, the peritoneum. The stomach, large and small intestines, liver, spleen, pancreas, kidneys, appendix, gallbladder, urinary bladder, major blood vessels, and nerves lie within the abdomen. Many people call this area by the common term belly.

The function of abdominal organs is digestion of food, absorption of nutrients by the body, and elimination of indigestible substances and wastes. In the female, the sexual organs are also located within the abdomen, whereas the male sex organs lie adjacent to it.

The abdominal walls not only protect the organs but hold them in place so that they can function properly.