Page 569 - Concise Pathology for Exam Preparation ( PDFDrive )

554 SECTION II Diseases of Organ Systems

Morphology

• Aldosterone-producing adenomas
• Solitary, small (less than 2 cm in diameter) and well circumscribed with yellow, cut
surface
• Affect patients in third to fourth decades; females are more commonly involved than
males
• Composed of lipid-laden cortical cells with the presence of eosinophilic, laminated
inclusions, known as spironolactone bodies found after treatment with the antihy-
pertensive drug spironolactone.
• Bilateral idiopathic hyperplasia
• Diffuse or focal hyperplasia of cells resembling those of normal zona glomerulosa
• Focal hyperplasia is wedge-shaped extending from periphery to centre of the gland
Q. Write briefly on adrenogenital syndromes.

Ans. Adrenogenital syndromes are disorders of sexual differentiation, eg, virilization and
feminization, caused by:
1. Primary gonadal disorders
2. Several adrenal disorders
Excess secretion of testosterone (Flowchart 20.12)

Anterior pituitary

Adrenal cortex
Dehydroepiandrosterone Androstenedione

Peripheral tissue

Testosterone
FLOWCHART 20.12. Regulation of testosterone secretion.

• Hypersecretion of sex steroids, mainly androgens, occurs as:
• A pure syndrome
• Component of Cushing syndrome
• May occur in children or adults
• In children, it is caused by congenital adrenal hyperplasia (total lack of a particular
enzyme involved in the biosynthesis of cortical steroids).
• In adults, it is caused by adrenal cortical adenomas and adrenal carcinomas.
Clinical features
• In children: Distortion of external genitalia in girls and precocious puberty in boys.
• In adults: Females show virilization (hirsutism, oligomenorrhoea and deepening of
voice) and males show feminization.

Q. Write briefly on the causes, clinical features and morphology of
adrenal insufficiency.

Ans. Adrenal insufficiency is classified into:
1. Primary and secondary insufficiency based on the underlying cause.
(a) Causes of primary insufficiency:
(i) Congenital adrenal hyperplasia
(ii) Adrenoleukodystrophy
(iii) Autoimmune adrenal insufficiency

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