1911 Encyclopædia Britannica/Supra-renal Extract

SUPRA-RENAL EXTRACT. The extract of the supra-renal gland is one of the most valuable remedies recently introduced in medicine. Feeding with the fresh gland of sheep was at first practised, but the sterilized glycerin preparation known as supra-renal extract is now used, the dose being 5 to 15 minims. The active principle of the gland, best known as adrenaline or epinephrine, occurs only in the medulla of the gland. It forms minute white crystals, soluble in weak solutions of hydrochloric acid. The U.S.P. contains a desiccated preparation, Glandulae suprarenales siccae. Adrenaline is most frequently used in 1% solutions of the chloride.

Adrenaline has no action on the unbroken skin, but locally applied to mucous membranes it causes blanching of the part owing to its powerful constriction of the capillaries by stimulating the muscular fibres of the vessel walls. It acts rapidly in a similar manner when hypodermically injected. The vessels of the uterus are strongly acted upon by it, but the effect on the cerebral vessels is slight, and the pulmonary vessels are unaffected. The heart is slowed and the systole increased. Adrenaline stimulates the salivary glands. It also produces a temporary glycosuria. In poisonous doses it causes haemorrhages into the viscera and oedema of the lungs.

In Addison’s disease the use of supra-renal extract has been beneficial in some cases, but its chief use is in the control of hemorrhage. For this purpose it is given in conjunction with local anaesthetics such as cocaine in order to produce bloodless operations on the eye, nose and elsewhere. It is also useful in hemorrhage from small vessels, where it can be applied at the bleeding spot, as in epistaxis. In menorrhagia and metrorrhagia it is also of service. In surgical shock and in chloroform syncope an injection of adrenaline often saves life through the rise of blood pressure produced. An attack of bronchial asthma may be cut short by a hypodermic injection of adrenaline solution. It should never be used in the treatment of haemoptysis. Similar commercial products on the market are hemisine, renaglandine, suprarenine, adnephrine, paranephrine and renostyptine. Supra-renal snuff containing the dry extract with menthol and boric acid is of use in hay fever. Rhmodyne is of this type. Suppositories containing supra-renal extract are used to check bleeding piles.

The chemistry of adrenaline has been mainly elucidated by the investigations of Pauly, Jowett and Bertrand; Jowett proposing a constitution (see annexed formula) now accepted as correct.

HO

HO·CH(OH)·CH₂·NHMe

Adrenaline.

Many substances having related constitutions have been synthesized, and it has been found that they resemble adrenaline in increasing the blood pressure. For example, the corresponding ketone, adrenal one (obtained in 1904 by Stolz) is active, and the methyl group can be replaced by hydrogen or another radical without destroying the activity. It seems that the para-hydroxyl group is essential For instance, para-hydroxyphenylethylamine, HO·C₆H₄CH₂·CH₂NH₂, which is one of the active bases of ergot, closely resembles adrenaline (G. Barger, Journ. Chem. Soc., 1909, 95, pp. 1123, 1720; K. W. Rosenmund, Ber., 1909, 42, p. 4778); as does also its dimethyl derivative horde nine, an alkaloid found in barley (G. Barger, ibid., p. 2193). Adrenaline is optically active, the naturally occurring isomer being the laevo form; it is interest mg to note that, like nicotine, the laevo base has a much greater physiological activity than the dextro.