Danny, I agree that adrenalectomies do seem a bit drastic, even though I have read that it is easier to control the level of hormones after an adrenalectomy.

I do have a question for you.  Why would the adrenal medulla shrink/atrophy in response to not being able to produce hormone(s)?  Wouldn’t the pituitary continue to call for the missing hormone as needed thus causing the adrenal medulla to work even harder to satisify that demand?  If it was working that much harder, it would enlarge, wouldn’t it - just like the adrenal cortex does when you have CAH?   

I have a sister-in-law who had an adrenal tumor a year ago. They removed it and now she, in effect, has LOCAH.  They had hoped the other adrenal gland would produce all the adrenal hormones she needs, but what they found was that it had shrunk and atrophied when she had the tumor due to the affected adrenal gland spewing out way too much hormones (which is why she exhibited all the Cushings symptoms when she had the tumor.)