Adrenal gland transplantation in clinical conditions

Abstract

Chronic insufficiency of the cortical substance of the adrenal glands or hypocorticism until recently belonged to rare forms of endocrine pathology. This included a few cases of Addison’s disease of tuberculous etiology, a relatively small number of patients after bilateral adrenalectomy for Cushing’s disease, removal of bilateral, sometimes unilateral, hormonally active tumors of the cortex and medulla of the adrenal glands. Bilateral adrenalectomy is also practiced for some types of hormone‑dependent tumors of the mammary glands, ovaries, prostate, and malignant hypertension. The evolution of ideas about the pathophysiology of adrenal glands contributed to a significant expansion and increase in the number of patients suffering from hypocorticism. A decrease in the incidence of tuberculosis contributed to a decrease in the number of patients with classic Addison’s disease. However, an increasing number of patients with hypocorticism of autoimmune, genetically determined and other genesis are currently being discovered. The improvement of diagnostic methods contributes to the increase in the number of operations for adrenal glands tumors and, accordingly, the number of cases of post‑adrenalectomy hypocorticism. Operations on the pituitary gland for various types of tumors, the number of which is steadily increasing, also contribute to the increase in the number of cases of hypothyroidism. In the mid‑70s of the XX century. a new direction in the treatment of various forms of endocrine insufficiency by the method of transplanting cultures of cells and tissues of endocrine glands took shape. Disorders of the endocrine glands seem to be particularly suitable for the transplantation method of treatment, since it is expected that living and functionally active donor endocrine tissue, transplanted into a patient with endocrine insufficiency, will secrete hormones and provide the body’s physiological needs and clinical compensation of the insufficiency. Similar experimental studies have been conducted since the beginning of the 20th century. The methods of obtaining cultures of cells and tissues of various endocrine organs were developed in detail, the issue of their viability, morphological and hormonal characteristics, and the possibility of compensation of certain forms of endocrine insufficiency were studied.