Adrenal cortical adenoma

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Adrenal cortical adenoma
Diagnosis in short

Adrenal cortical adenoma. H&E stain.
LM DDx adrenal cortical nodule, adrenal cortical hyperplasia, adrenal cortical carcinoma
Site adrenal gland

Prevalence relatively common
Radiology adrenal mass, HU<10
Prognosis benign
Treatment followup or surgical excision

Adrenal cortical adenoma, also adrenocortical adenoma and adrenal adenoma, is a relatively common benign pathology of the adrenal gland.

General

Epidemiology:

  • Often an incidental finding.

Pathologic/clinical:

  • Radiologists are good at identifying adenomas, as they are usually lipid rich and have a characteristic low HU signal (<10 HU[2]).
    • Microadenomas may be missed.[1][3]

Indications for excision:[4][5]

  • Lesions >30 mm.
  • Hormonally active.
  • Non-incidental finding. (???)
  • Adrenal vein sampling (AVS) suggestive of adenoma.[1]

Notes:

  • 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).

Microscopic

Classic features:

  • Well-defined cell borders.
  • Clear cells (abundant, finely vacuolated cytoplasm)
  • Polygonal pink cells.
  • Most of the nuclei are bland, central and round.
  • May have foci of necrosis/degeneration and nuclear atypia.

Note:

  • In aldosterone producing tumours:
    • May extend outside of the capsule (should not be diagnosed as adrenal cortical carcinoma).
    • No atrophy of non-hyperplastic cortex.
    • May show spironolactone bodies if hypertension treated with spironolactone prior to surgery.

DDx:

Images

See also

References

  1. 1.0 1.1 1.2 Myint, KS.; Watts, M.; Appleton, DS.; Lomas, DJ.; Jamieson, N.; Taylor, KP.; Coghill, S.; Brown, MJ. (Jun 2008). "Primary hyperaldosteronism due to adrenal microadenoma: a curable cause of refractory hypertension.". J Renin Angiotensin Aldosterone Syst 9 (2): 103-6. doi:10.3317/jraas.2008.015. PMID 18584586.
  2. Tenenbaum, F.; Lataud, M.; Groussin, L. (Apr 2014). "[Update in adrenal imaging].". Presse Med 43 (4 Pt 1): 410-9. doi:10.1016/j.lpm.2014.02.002. PMID 24636681.
  3. Fujiwara, M.; Murao, K.; Imachi, H.; Yoshida, K.; Muraoka, T.; Ohyama, T.; Kushida, Y.; Haba, R. et al. (Oct 2010). "Misdiagnosis of two cases of primary aldosteronism owing to failure of computed tomography to detect adrenal microadenoma.". Am J Med Sci 340 (4): 335-7. doi:10.1097/MAJ.0b013e3181e95587. PMID 20881759.
  4. Luton, JP.; Martinez, M.; Coste, J.; Bertherat, J. (Jul 2000). "Outcome in patients with adrenal incidentaloma selected for surgery: an analysis of 88 cases investigated in a single clinical center.". Eur J Endocrinol 143 (1): 111-7. PMID 10870039.
  5. Liu, XK.; Liu, XJ.; Dong, X.; Kong, CZ. (Jun 2008). "[Clinical research about treatment for adrenal incidentalomas]". Zhonghua Wai Ke Za Zhi 46 (11): 832-4. PMID 19035218.
  6. Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 200. ISBN 978-0443066856.
  7. IAV. 18 February 2009.