Adrenal Morphology

Question 1

– Most common change seen with high levels of endogenous or exogenous glucocorticoids
– Corticotroph cells becomes homogeneous and pale. Why is this?

Answer 1

Crooke hyaline change

Homogenous and pale because intermediate keratin filaments accumulate in the cytoplasm

Question 2

Seen when exogenous glucocorcoids → suppression of ACTH → lack of stimulation of the zonae fasciculata and reticularis

Answer 2

Cortical atrophy

Question 3

– Endogenous hypercortisolism
– ACTH‐dependent Cushing syndrome
– Cortexcanbevariablynodular

Answer 3

Diffuse hyperplasia (both glands enlarge)

Question 4

– Endogenous hypercortisolism
– Adrenals almost entirely replaced by prominent nodules of varying sizes (≤3 cm)
– Areas between the macroscopic nodules also demonstrate evidence of microscopic nodularity

Answer 4

Macronodular hyperplasia

Question 5

– Endogenous hypercortisolism

– Composed of 1‐to3‐mm darkly pigmented (brown to black; lipofuscin) micronodules, with atrophic intervening areas

Answer 5

Micronodular hyperplasia

Question 6

• Age 30-50
  – Morphologically indistinct
  – Functional tumors: adjacent adrenal cortex and the contralateral adrenal gland are atrophic

Answer 6

Functional (Cushing Syndrome) or non-functional Primary Adrenocortical Neoplasm

Question 7

– YELLOW tumors surrounded by thin or well‐developed capsules
– Most weigh less than 30

Answer 7

Adrenal adenomas (benign)

Question 8

– Larger than the adenomas (usually >200‐300gm)

– Unencapsulated

Answer 8

Carcinomas (malignant)

Question 9

Characteristic of what?
– Eosinophilic, laminated cytoplasmic inclusions
– Found after treatment with spironolactone (antihypertensive drug)

Answer 9

Adrenal adenoma - these are spironolactone bodies.

Question 10

• 30‐40 years
• W>M
• Left > right
• Usually solitary
• Small (

Answer 10

Adrenal adenoma

Question 11

If an adrenal adenoma is present, what is seen in adjacent adrenal cortex and contralateral gland?

Answer 11

Do not suppress ACTH secretions, so not atrophic.

Question 12

• Adrenals are bilaterally hyperplastic
• Cortex is thickened and nodular
• Cortex looks brown

Answer 12

CAH

Question 13

Why does cortex look brown in CAH?

Answer 13

Due to total depletion of all lipid

Question 14

What is this?
– Irregularly shrunken adrenal glands, which may be difficult to identify grossly.
– Histologically:
• Cortex contains scattered residual cortical cells in a collapsed network of connective tissue
• Variable lymphoid infiltrate

Answer 14

Primary Autoimmune Adrenalitis

Question 15

When adrenal architecture is effaced by a granulomatous inflammatory reaction

Answer 15

Tuberculous and fungal disease

Question 16

When normal adrenal architecture obscured by the infiltrating neoplasm

Answer 16

Metastatic adrenal carcinoma

Question 17

• Most are clinically silent and discovered incidentally
• Well‐circumscribed nodular lesion
• Up to 2.5 cm in diameter
• Usually yellow to yellow‐brown

Answer 17

Adrenocortical Adenoma

Question 18

• Cortex adjacent to nonfunctional v. functional adenomas

Answer 18

• Cortex adjacent to nonfunctional adenomas is normal

– V.s. functional adenoma where it’s usually atrophic

Question 19

Why are adrenocortical adenomas yellow/brown?

Answer 19

Presence of lipid.

Question 20

Childhood, rare. Likely functional and assoc with virilism. Large, invasive, >20cm diameter. Hemorrhagic, necrotic on cut surface.

Answer 20

Adrenocortical carcinoma.

Question 21

What vessels do adrenocortical carcinomas generally invade?

Answer 21

Adrenal vein, vena cava, lymphatics.

Question 22

adrenocortical carcinomas generally met to?

Answer 22

Regional and periaortic nodes, lungs, other viscera

Question 23

Familial paraganglioma 1 and 4; pheochromocytoma and paraganglioma

Answer 23

Pheochromocytoma

Question 24

• Usually multifocal
• Foci of C-cell hyperplasia in adjacent thyroid
• Usually clinically aggressive.

Answer 24

Medullary carcinoma of the thyroid (in 100% of MEN-2A)