79-year-old male suffered from metastasized carcinoma of the colon (specimen from autopsy).
- The architecture of the adrenal cortex is maintained, the zona glomerulosa, fasciculata and reticularis can readily be distinguished.
- In hyperplasia both, the zona fasciculata and to a lesser degree, the zona reticularis are widened.
- The cells are larger than usual (hypertrophy) and the absolute number of cells is increased (hyperplasia).
Pathogenesis: Acquired hyperplasia of the adrenal cortex is always bilateral. A diffuse and a nodular form are distinguished. The first is caused by inadequate ACTH production and is thus referred to as the ACTH-dependent form. In contrast, nodular hyperplasia usually arises independent of an increased ACTH-production, and is therefore referred to as the ACTH-independent form.
Macroscopy: The adrenal glands are enlarged. In adults, an adrenal gland weighing above 6 g is considered hyperplastic. The adrenal cortex is diffusely thickened and yellow. Normally, the width of the adrenal cortex is around 1mm and exhibits a yellow and brown color (zona fasciculata and reticucularis).