Adrenocortical Tumors: Recent Advances in Basic Concepts and Clinical Management

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   Figure 1. Intermingling of adrenocortical and chromaffin tissue. Chromaffin cells are immunostained red with antibodies to chromogranin A (Clone Dako A3, Dako, Copenhagen, Denmark; original magnification, ×200). Endothelial cells immunostained with antibodies to CD31 (Dako) ( ) are in direct contact with adrenocortical cells in the zona fasciculata ( ). The reaction was visualized with 3-amino-ethylcarbasole (original magnification, ×800). Electron µgraph of a nerve cell ( ) in apposition with an adrenocortical cell. The latter shows vesicular mitochondria ( ) and extends filopodia ( ) to the nerve cell. Scale, 0.5 µm. Electron µgraph of a macrophage in direct contact with adrenocortical cells. Macrophages show lysosomes ( ), rough endoplasmic reticulum ( ), and pinocytotic vesicles ( ). Adrenocortical cells have ample mitochondria with characteristic vesicular internal membranes, smooth endoplasmic reticulum, and Golgi complex ( ). Scale, 1 µm. NUC = nucleus. Histologic characteristics of the normal human adrenal gland. A.B.arrowsZFC.NERVMITarrowsD.LYRERarrowsGolgi
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   Figure 2. Adrenal nodules ( ) originating within the adrenal medulla ( ). Medullary cells are stained with an antibody to chromogranin A (original magnification, ×60). Lymphocytic infiltration in a cortisol-producing adrenal adenoma causing the Cushing syndrome. Lymphocytes characterized with antibodies to CD45 (Clone 2B 11, Dako, Copenhagen, Denmark) are in direct contact with adrenal tumor cells. No signs of autoimmune disease or inflammation were seen in this patient. The reaction was visualized with 3-amino-ethylcarbasole (original magnification, ×200). C = cortex. Immunostaining of specimens of adrenal adenoma. A.NODMB.
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   Figure 3. This algorithm suggests tests that are used for screening, confirmation, and localization of aldosterone-producing tumors. To convert aldosterone values to pmol/L, multiply by 27.744; to convert urinary aldosterone excretion to nmol/d, multiply by 2.774; to convert 18-hydroxycorticosterone values to nmol/L, multiply by 0.0276. If there is more than one item, follow the respective numbers throughout the algorithm. CT = computed tomography; MRI = magnetic resonance imaging. Diagnostic algorithm for primary hyperaldosteronism.
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   Figure 4. For the diagnosis of primary hypercortisolism, this algorithm suggests tests that are used for screening, confirmation, and localization of a cortisol-producing or corticotropin ( )-producing tumor. To convert serum cortisol values to nmol/L and to convert urine free cortisol values to nmol/d, multiply by 2.759. If there is more than one item, follow the respective numbers throughout the algorithm. BIPSS = bilateral inferior petrosal sinus sampling (measurement of plasma corticotropin concentrations in the inferior petrosal sinuses and a peripheral vein ); CRH = corticotropin-releasing hormone; CT = computed tomography; MRI = magnetic resonance imaging. Diagnostic algorithm for the Cushing syndrome.ACTH[114]
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   Figure 5. Adrenal CT of a 61-year-old woman with primary hyperaldosteronism and bilateral adrenal nodules ( ) did not identify an increased lipid content in either adenoma. In-phase MRI also failed to differentiate between the two sides. A loss of signal content of the functional aldosteronoma was shown by out-of-phase MRI. Venous sampling and surgery confirmed a right aldosteronoma. (Courtesy of J.L. Doppman). Computed tomography (CT) and magnetic resonance imaging (MRI) of aldosterone-secreting adenomas. Top.arrowsMiddle.Bottom.

• Copyright ©2004 by the American College of Physicians