Die Nebennierenrinde

[Ectopia of the adrenal]

Ectopia of nodular adrenocortical tissue is very frequently found in the periadrenal region. It corresponds to accessory adrenal tissue and is a normal variant. Ectopia in more distant regions are found in inner male or female genitalia. Strong long-lasting hyperstimultions induce hyperplasia and simulate true tumors ("adrenal rest tumors"). Real autonomic tumors from ectopic adrenal tissue with or without hyperfunction are rare. Ectopia of adrenomedullary tissue are nearly exclusively found in the surroundings of normal medulla. Ectopia in the adrenals corresponds almost exclusively with thyroid tissue. Ectopic secretion of hormones, mostly ACTH, can be found in pheochromocytomas and induces hyperfunction (Cushing's syndrome).

[Adrenalitis]

Inflammation of the adrenal glands is caused by autoimmunopathies or infections and can induce adrenal insufficiency. Autoimmune lymphocytic adrenalitis is often combined with other autoimmune diseases and the most frequent cause of Addison's disease; however, it only becomes clinically apparent when more than 90 % of the adrenal cortex has been destroyed. Histological features are characterized by lymphoplasmacytic inflammation leading to an increased destruction of adrenocortical tissue but less severe courses can also occur. The second most frequent form of adrenalitis is adrenal tuberculosis, showing typical granulomatous findings that are nearly always caused by spreading from a tuberculous pulmonary focus. Other bacterial as well as viral infections, such as Epstein-Barr virus (EBV), cytomegalovirus (CMV) and others, generally affect the adrenal glands only in patients with immunodeficiency disorders. In these infections, the adrenal cortex and medulla are frequently involved to roughly the same extent. Although surgical specimens from inflammatory adrenal lesions are extremely rare, the various forms of adrenalitis play an important role in the post-mortem examination of the adrenal glands for clarification of unclear causes of death (e.g. death during an Addisonian crisis).

Fat-Cell Metaplasia in the Adrenal Cortex: Incidence, Structure, and Correlation to Basic Diseases in a Postmortem Series

In a postmortem series of adrenals from 497 patients 25 cases (5%) showed foci of fat-cell metaplasia or bone-marrow metaplasia in the zona fasciculata or the zona reticularis. There was only one focus in 45% of adrenals with metaplasia, but in 36.4%. more than six foci were present. The sizes varied between 0.036 and 0.64 mm. The foci were composed of mature, mostly univacuolar, fat cells and various amounts of myeloid cells The incidence of fat-cell metaplasia or of bone marrow metaplasia correlated with arterial hypertension and severe coronary heart disease. In 76% of cases, nodular hyperplasia was demonstrable, but the metaplasia were more often found adjacent to, rather than within, the nodules. They appear to be related to metaplasia in adrenocortical tumors and to myelolipomas. The common pathogenesis is thought to be based on focal necroses in combination with local endocrine stimulation.

Myelolipoma of the adrenal gland associated with contralateral renal cell carcinoma: case report and review of the literature

Adrenal myelolipoma is a rare benign hormonally inactive tumor. It is frequently detected incidentally on new imaging procedures, such as sonography and computerized tomography and, thus, the question of treatment arises. The association of myelolipomas with obesity, hypertension and malignant tumors has been described previously. We report the second case of myelolipoma associated with renal cell carcinoma. Pathogenesis, differential diagnosis and therapy are discussed.

The effect of cyproterone and gonadotrophins on the adrenal gland of juvenile and adult rats. A morphological and morphometrical study

Up to now the question whether antiandrogens and gonadotrophins cause a reaction of the adrenal cortex has not been settled. 32 juvenile and 32 adult male albino rats were divided into 4 groups with 8 animals each. One group of juvenile and of adult rats were treated with cyproterone (Cp) as an anti-androgen, Primogonyl (Pg) served as an LH equivalent and Pergonal (Per) as a FSH-LH dose. One group of juvenile and adult rats served as controls. The animals were killed on the 28th day of the experiment. Microphotographic black-and-white pictures from the histologic adrenal cortex specimens were taken with a magnification of 800. The morphometric and histologic evaluation of the adrenal cortex was carried out separately for the zona glomerulosa (z.g.), the zona fasciculata (z.f.) and the zona reticularis (z.r.). No measurable changes can be found in the z.g. under experimental conditions. Both the juvenile and the adult rats exhibit a distinct atrophy of the z.f. and the z.r. after the administration of Cp and gonadotrophins. The severest regressive transformations can be observed in the adult rats after Cp was given. The atrophy of z.f. and z.r. is obviously due to the inhibition of corticotropic regulation in the hypothalamic-hypophysic axis. This is astonishing in so far as this regulation is usually responsible for the production of glucocorticoid and only to a lesser degree for the production of sex hormone. A glucocorticoid-like effect of Cp is assumed. Similar changes are also caused by the administration of gonadotrophins.