68-year-old female was under long-term therapy with corticosteroids because of rheumatoid arthritis (specimen from autopsy).
- The overall architecture of the adrenal gland is maintained. However, the cortex is markedly narrowed and the capsule is more prominent.
- Over wide sections, the zona glomerulosa predominates in the cortex and the zona fasciculata and reticularis are not readily distinguished.
Pathogenesis: A primary and secondary form of adrenocortical insufficiency is distinguished.
Primary chronic adrenocortical insufficiency (Addison disease) may be caused by autoimmune adrenalitis, infections (tuberculosis), metastatic neoplasms and genetic disorders.
Secondary adrenocortical insufficiency is most frequently caused by long-term corticosteroid administration, which leads to a hypothalamic-pituitary suppression and thus, inadequate ACTH production. After discontinuation of treatment, this type of adrenocortical insufficiency is reversible. In addition, neoplasms or inflammatory processes of hypothalamus and pituitary gland will also cause secondary insufficiency.