Adrenal gland & paraganglia

Adrenal hyperfunction / hyperplasia

Acquired adrenal cortical hyperplasia

Topic Completed: 1 February 2013

Minor changes: 8 June 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Acquired adrenocortical hyperplasia

Nat Pernick, M.D.
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Cite this page: Pernick N. Acquired adrenal cortical hyperplasia. website. Accessed October 22nd, 2021.
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

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Bilateral cortical hyperplasia

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