From anatomy to therapy: the historical journey to cortisone

To comprehensively trace the historical journey of adrenal gland research from the first anatomical descriptions in the 16th century to the development and clinical application of cortisone in the mid-20th century.

This review examines key phases in adrenal gland research, including anatomical discoveries, microscopic studies, experimental physiology, biochemical advancements, and clinical applications. We analyzed primary historical sources, scientific papers, and medical records to construct a chronological narrative of adrenal gland understanding and cortisone development.

The review highlights significant milestones, beginning with Bartolomeo Eustachio's 1564 discovery of the adrenal glands. It details the crucial microscopic phase, initiated by Moritz Nagel's 1836 study, which revealed the cortex-medulla distinction. Julius Arnold's 1866 description of the three-zone cortical structure and the identification of chromaffin cells are also discussed. The experimental physiology phase, featuring groundbreaking work by Thomas Addison and Charles-Édouard Brown-Séquard, established the vital role of the adrenal cortex. The biochemical phase, marked by the isolation and synthesis of cortisone, is examined in depth, with particular focus on the contributions of Edward Calvin Kendall, Tadeus Reichstein, and others. Finally, the clinical phase is detailed, emphasizing Philip Showalter Hench's revolutionary application of cortisone in rheumatoid arthritis treatment in 1948.

This historical journey demonstrates how advancements in anatomy, histology, physiology, and biochemistry synergistically contributed to our understanding of the adrenal glands. The development of cortisone, culminating with this collective knowledge, revolutionized the treatment of inflammatory diseases, marking a significant milestone in medical history and setting the stage for modern endocrinology and rheumatology.