Adrenal cortical adenoma: Difference between revisions
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| Micro = | | Micro = | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = adrenal cortical nodule, | | LMDDx = adrenal cortical nodule, adrenal cortical hyperplasia, [[adrenal cortical carcinoma]] | ||
| Stains = | | Stains = | ||
| IHC = [[calretinin]], inhibin | | IHC = [[calretinin]], inhibin | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = cortisol-producing (PRKACA, GNAS1, MENIN, ARMC5, APC, FH, PRKAR1A, PDE11A, PDE8B), aldosterone-producing (KCNJ5, ATP1A1, ATP2B3, CACNA1D, CTNNB1), non-secreting (CTNNB1) | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
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| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = relatively common | | Prevalence = relatively common | ||
| Bloodwork = | | Bloodwork = +/-cortisol elevation, +/-aldosterone elevation | ||
| Rads = adrenal mass, HU<10 | | Rads = adrenal mass, HU<10 | ||
| Endoscopy = | | Endoscopy = | ||
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*[[Cushing disease]] is due to the ACTH over-production by the [[pituitary]]. | *[[Cushing disease]] is due to the ACTH over-production by the [[pituitary]]. | ||
*In cortisol producing tumours (''Cushing syndrome''): atrophy of the non-hyperplastic cortex (due to feedback inhibition from the [[pituitary gland]]). | *In cortisol producing tumours (''Cushing syndrome''): atrophy of the non-hyperplastic cortex (due to feedback inhibition from the [[pituitary gland]]). | ||
===Serology and genes=== | |||
The serology in adenoma has been associated with certain genes:<ref name=pmid30969728>{{cite journal |authors=Mahmood E, Loughner CL, Anastasopoulou C |title= |journal= |volume= |issue= |pages= |date= |pmid=30969728 |doi= |url=}}</ref> | |||
{| class="wikitable sortable" | |||
!Serology | |||
!Gene(s) | |||
|- | |||
|non-secreting adenoma | |||
|CTNNB1 | |||
|- | |||
|cortisol-producing | |||
|PRKACA, GNAS1, MENIN, ARMC5, APC, FH, PRKAR1A, PDE11A, PDE8B | |||
|- | |||
|aldosterone-producing | |||
|KCNJ5, ATP1A1, ATP2B3, CACNA1D, CTNNB1 | |||
|} | |||
Note: | |||
*Androgen producing adenomas are rare; androgen production more common in [[adrenal cortical carcinoma]].<ref name=pmid30969728/> | |||
==Microscopic== | ==Microscopic== | ||
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None of the following are present in the cortex: | None of the following are present in the cortex: | ||
High nuclear grade, high mitotic rate (mitotic activity | High nuclear grade, high mitotic rate (mitotic activity >5/50 HPF, | ||
where 1 HPF~=0.2376 mm*mm), atypical mitoses, sheeting, necrosis, | where 1 HPF~=0.2376 mm*mm), atypical mitoses, sheeting, necrosis, | ||
sinusoidal invasion, venous invasion, capsular invasion. | sinusoidal invasion, venous invasion, capsular invasion. | ||