The Human Adrenal Cortex: Pathology and Biology -- An Integrated Approach

ISBN-13: 9781447113195 / Angielski / Miękka / 2011 / 354 str.

A. M. Neville; M. J. O'Hare

Opis

We would like to take this opportunity of expressing our sincerest thanks to the many persons who have made adrenal tissue and related materials available to us for our work. Our especial gratitude is extended to Drs. J. J. Brown, A. Lever and J. I. S. Robertson of the M.R.C. Blood Pressure Unit, Glasgow, Dr. J. K. Grant, Royal Infirmary, Glasgow, Professor R. B. Welbourn and Dr. W. Kelly, Royal Postgraduate Medical School, Drs. D. B. Grant of Great Ormond Street, J. Ginsberg, Royal Free Hospital, D. C. Anderson, Hope Hospital, Salford, C. R. Edwards, St. Bartholomew's Hospital and Professor I. Doniach (for- merly of the London Hospital) and Messrs. J.-c. Gazet, A. McKinna and P. Greening, Royal Marsden Hospital, London. The preparation and presentation of the material and the results would not have been possible without the help of Dr. P. Monaghan and his Electron Microscopy Unit, Ludwig Institute for Cancer Research (London Branch), Sutton, Mrs. Mitchell and her Histology Team, Royal Marsden Hospital, Sutton, Mr. K. Moreman of the Photographic Department of the Royal Marsden Hospital and Institute of Cancer Research, London and Mr. M. Hughes for graphics. Particular thanks are due for the untiring efforts and assistance ofMr. J. Ellis and Mrs. D. Corney of the Ludwig Institute for Cancer Research (London Branch), Sutton, for most of the photographic and secretarial work respectively. Professors G. Dhom and E. Mausle kindly provided material for Figs.

Spis treści

1. Introduction.- 2. Historical Aspects.- A. The Normal Adrenal Cortex.- 3. Origin and Development of the Adrenal Gland.- Embryology.- Fetal Development.- Postnatal Development.- 4. Structure of the Adult Adrenal Cortex.- Gross Anatomy.- Weight.- Blood Supply.- Light-Microscopic and Ultrastructural Appearance.- The Normal Gland.- The Effects of Adrenocorticotrophic Hormone (ACTH).- Intraglandular Vascularisation.- Lymphatic Supply.- Innervation.- 5. The Effect of Stress on the Structure of the Adrenal Cortex.- 6. Morphological Changes in the Adrenal Cortex with Age.- The Prenatal Cortex.- The Neonatal and Prepubertal Cortex.- The Postpubertal Cortex.- Adrenocortical Nodules.- The Autopsy ‘Black’ Nodule.- 7. Iatrogenic Changes.- ACTH.- Steroid Therapy.- Inhibitors of Adrenal Steroidogenesis.- Aminoglutethimide.- Spironolactone.- O,p’-DDD (Mitotane, Lysodren).- Other Inhibitors.- 8. Functional Activity of the Adrenal Cortex.- Adrenal Chemistry.- Steroids.- Lipids.- Vitamins.- Hormonogenesis by the Adult Adrenal Cortex.- Pathways of Steroidogenesis.- Molecular Mechanisms of Steroidogenesis.- Inhibitors of Steroidogenesis.- Control of Adult Steroidogenesis.- Glucocorticoids.- Mineralocorticoids.- Sex Steroids.- Hormonogenesis by the Prepubertal and Pubertal Cortex.- Hormonogenesis by the Prenatal Adrenal Cortex.- Pathways of Steroidogenesis.- The Feto-placental Unit.- Functions of Fetal Adrenal Steroids.- Control of Prenatal Hormonogenesis.- 9. Regulation of Growth of the Adrenal Cortex.- The Prenatal Gland.- Growth.- Involution.- The Postnatal Gland.- Adult Tissue Homeostasis and Regenerative Growth.- 10. Functional Zonation of the Adrenal Cortex.- Zonal Functions of the Cortex.- Mechanisms of Functional Zonation.- B. Hypercorticalism.- 11. General Incidence and Pathological Changes.- Factors Predisposing to Hypercorticalism.- 12. Cushing’s Syndrome.- Bilateral Adrenocortical Hyperplasia.- Simple (or Diffuse) Hyperplasia.- Bilateral Nodular Hyperplasia.- Hyperplasia and the ‘Ectopic ACTH’ Syndrome.- Congenital and Familial ‘Idiopathic’ Cushing’s Syndrome with Hyperplasia.- Infantile Onset.- Pubertal/Adult Onset.- Adrenocortical Tumours.- Adenomas.- Carcinomas.- The Attached and Contralateral Adrenal Gland.- Prognosis.- 13. The Adrenogenital Syndrome and Related Conditions.- Congenital Adrenocortical Hyperplasia (CAH).- CAH With Virilism.- 21-Hydroxylase Deficiency...- 11 ß-Hydroxylase Deficiency.- ?5-3ß-Hydroxysteroid Dehydrogenase-isomerase Deficiency.- Pathology of CAH With Virilism.- Non-virilising CAH Syndromes and Related Defects...- 17-Hydroxylase Deficiency.- Defective Cholesterol Utilisation.- Defective Aldosterone and 18-hydroxycorticosterone.- Biosynthesis (Corticosterone Methyl Oxidase Type I and Type II Deficiencies).- C17–20 Desmolase (Lyase) Deficiency.- Pathology of CAH Without Virilism.- Genetics of CAH.- Virilising Adrenocortical Tumours.- Incidence and Symptoms.- Functional Properties.- Pathology.- Prognosis.- Adrenal Tumours Causing Feminisation.- Incidence and Symptoms.- Functional Properties.- Pathology.- Prognosis.- Testicular Changes.- Attached and Contralateral Adrenal Gland in the.- Adrenogenital Syndrome With Tumours.- Non-tumorous Adrenal Feminisation.- 14. The Distinction Between Benign and Malignant Adrenocortical Tumours Causing Cushing’s and/or the Adrenogenital Syndromes: Structural and Functional Criteria.- Morphology.- Function.- Autonomy.- Aetiology of the Abnormal Steroidogenesis.- Conclusions.- 15. Hyperaldosteronism and Related Syndromes of Mineralocorticoid Excess.- Hyperaldosteronism With Low Plasma Renin (Primary Aldosteronism).- Symptoms and Incidence.- Pathology.- Incidence of Pathological Adrenal Changes in Primary Aldosteronism.- Adrenocortical Tumours.- Prognosis.- The Attached and Contralateral Adrenal Gland in Tumorous Primary Aldosteronism.- Non-tumorous Hyperaldosteronism With Low Plasma Renin.- Hyperaldosteronism With High Plasma Renin (Secondary Aldosteronism).- Bartter’s Syndrome (‘Tertiary’ Aldosteronism).- Syndromes of Mineralocorticoid Excess Without Hyperaldosteronism.- Congenital.- Acquired.- Non-tumorous.- Adrenocortical Tumours.- Aetiology and Correlation of Structure and Function in Conn’s Syndrome.- Tumour Structure and Function.- Structure and Function of the Attached Gland.- The Relationship of Nodules and Adenomas in Conn’s Syndrome: a Possible Functional Continuity?.- 16. ‘Non-functioning’ (Non-hormonal) Adrenocortical Tumours.- Incidence and Symptoms.- Functional Activity.- Pathology.- Prognosis.- The Attached and Contralateral Gland in Non-hormonal Adrenocortical Tumours.- C. Hypocorticalism.- 17. Acute Acquired Adrenoprivic Hypocorticalism.- 18. Chronic Acquired Adrenoprivic Hypocorticalism (Addison’s Disease).- Organ-specific Autoimmune Adrenalitis (Idiopathic Addison’s Disease).- Pathology.- Aetiology.- Adrenoleukodystrophy (Addison-Schilder’s Disease).- Incidence and Symptoms.- Pathology.- Adrenal Cortex.- Other Tissues.- Aetiology of Adrenal Changes in Adrenoleukodystrophy.- Tuberculosis of the Adrenal Gland.- Pathology.- Amyloidosis.- Pathology.- Metastatic Carcinoma.- Miscellaneous Causes Including Non-tuberculous Infections.- 19. Congenital Adrenoprivic Hypocorticalism.- Idiopathic Congenital Adrenocortical Hypoplasia and the Syndrome of ACTH Unresponsiveness.- Incidence and Symptoms.- Pathology.- Congenital Adrenal Hyperplasia.- 20. Tropoprivic Hypocorticalism.- Acquired.- Iatrogenic.- Pituitary-derived.- Congenital.- Incidence.- Pathology.- D. Other Pathological Changes.- 21. Haemorrhage and Necrosis.- Incidence.- Signs and Symptoms.- Pathology.- Aetiology.- Prognosis.- 22. Congenital Defects of Adrenal Development.- Malformations and Heterotopias.- Adrenal Rests and Accessory Adrenal Glands.- Incidence and Distribution.- Hyperplasia and Tumours of Accessory Adrenocortical Tissue.- Ectopic Tissues Within the Adrenal Cortex.- Gonadal Cells.- Other Tissues.- Congenital Adrenocortical Cytomegaly.- ‘Idiopathic’ Congenital Cytomegaly.- Cytomegaly in the Beckwith-Weidemann Syndrome...- 23. Myelolipoma and Related Changes.- Incidence and Symptoms.- Pathology.- Aetiology.- 24. Cysts.- Incidence and Symptoms.- Pathology.- 25. Miscellaneous Changes.- Erythroblastosis Fetalis.- Haemochromatosis.- Syphilis Î.- Malacoplakia.- Wolman’s Disease.- Post-irradiation Fibrosis.- Appendix A. Plasma Steroids.- Appendix B. Urinary Steroids.- References.