Adrenal gland and paraganglia
Adrenal hyperfunction / hyperplasia
Acquired (noncongenital) adrenocortical hyperplasia



Topic Completed: 1 February 2013

Revised: 4 June 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Acquired adrenocortical hyperplasia


Nat Pernick, M.D.
Page views in 2018: 2,179
Page views in 2019 to date: 1,010
Cite this page: Pernick N. Acquired (noncongenital) adrenocortical hyperplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/adrenalacquiredhyper.html. Accessed June 17th, 2019.
Definition / general
  • Defined as nonneoplastic increase in adrenal cortical cells
  • Diffuse (62%) or nodular (20%) or hyperplasia with ectopic ACTH syndrome due to tumors (18%)
  • Diffuse cases are usually bilateral, associated with elevated ACTH produced by pituitary gland, ACTH-producing tumor or excess corticotropin-releasing factor production and rarely due to ACTH receptor autoantibodies (as with Grave disease)
  • Nodular cases usually are unrelated to ACTH production; may represent a later stage of diffuse hyperplasia, in which the lesion has evolved from ACTH-dependent to adrenal gland dependent
  • Associated with MEN1 (not neoplastic in one case, Mod Pathol 1999;12:919; also thyroid neoplasms, leiomyomas, hepatic focal nodular hyperplasia and renal angiomyoliomas
Case reports
Gross description
  • Nodular variant: at least one nodule 0.5 cm in diameter, often diffusely nodular adrenal cortex which weighs 6+ grams without fat; glands have rounded edges
Gross images

Images hosted on other servers:

Bilateral cortical hyperplasia

Nodular

Microscopic (histologic) description
  • Increased thickness of zona reticularis and fasciculata
  • Cells in fasciculata may appear lipid depleted
  • Atypical cells with large hyperchromatic nuclei may be present in nodules (“endocrine atypia”)
  • Small micronodules may be present near central vein, containing lipid-laden clear cells similar to zona fasciculata
Microscopic (histologic) images

Images hosted on other servers:

Diffuse hyperplasia

Lipomatous metaplasia

Molecular / cytogenetics description
  • Cells may be aneuploid or polyploid
Electron microscopy description
  • Abundant smooth endoplasmic reticulum, long microvilli
Differential diagnosis
Back to top