Adrenal gland & paraganglia

Other nonneoplastic

Focal adrenalitis

Topic Completed: 1 May 2017

Minor changes: 16 August 2021

Copyright: 2002-2021,, Inc.

PubMed Search: focal adrenalitis

Lan L. Gellert, M.D., Ph.D.
Page views in 2020: 277
Page views in 2021 to date: 286
Cite this page: Gellert LL. Focal adrenalitis. website. Accessed November 29th, 2021.
Definition / general
  • Aggregates of lymphocytes and plasma cells in adrenal gland
  • Usually incidental finding
  • Common in elderly
  • Uncertain, possibly immune mediated
Clinical features
  • Clinically apparent only after more than 90% of the adrenal cortex destroyed
Microscopic (histologic) description
  • Aggregates of lymphocytes and plasma cells, often perivascular, in adrenal cortex and medulla‚Ä®
Microscopic (histologic) images

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Various images

Positive staining - disease
  • Most infiltrating cells are CD3+ T cells, which primarily express CD4; CD8+ T cells are fewer
  • A considerable proportion of CD4+ T cells were considered activated based on interleukin 2 receptor expression (Clin Exp Immunol 1989;77:101)
Differential diagnosis
  • Autoimmune adrenalitis: Inflammation more diffuse, sometimes with follicle formation; often associated with marked cortical atrophy
  • Adrenal tuberculosis: granulomatous inflammation in adrenal gland
  • Viral infection in adrenal gland: CMV, EBV infection, usually in patients with immunodeficiency disorders
  • Xanthogranulomatous adrenalitis: diffuse histiocytic inflammation in adrenal gland, with occasional lipofuscin crystals and focal necrosis (Endocr Pathol 2015;26:229)
Board review style question #1
The infiltrating lymphocytes in focal adrenalitis are mainly composed of:

  1. CD4+ T cells
  2. CD8+ T cells
  3. CD20+ B cells
  4. CD56+ NK T cells
  5. Histiocytes
Board review style answer #1
A. CD4+ T cells. Most infiltrating cells are CD4+ T cells; CD8+ T cells are fewer

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