The adrenal gland has been known to be a common site of opportunistic infections and tumors that define the acquired immunodeficiency syndrome (AIDS) ever since the first autopsy data were published. We have examined the adrenal glands of 66 AIDS patients autopsied in New York City and tabulated and graded the findings in an attempt to estimate the likelihood of adrenal insufficiency developing on the basis of these lesions. AIDSdefining conditions were found in the adrenal glands of 56% of patients, primarily opportunistic infections (53%) and much less frequently neoplasms (3%). Cytomegaloviral (CMV) infection was by far the most common type (42%), followed by mycobacterial (8%) and fungal infections (3%). There was one case eachof Kaposi’s sarcoma and lymphoma. Total necrosis of adrenal cortex was restricted to 2 cases of tuberculosis. CMV adrenalitis, although the most common infection and often associated with necrosis, never resulted in more than 30% destruction of the cortex. We conclude that although histopathological evidence of adrenal disease is common in AIDS, most such lesions are not sufficiently extensive to result in adrenal insufficiency. In contrast to previous reports stressing the importance of CMV adrenalitis as a possible cause of adrenocortical insufficiency, we now find tuberculosis the more likely cause of total cortical destruction.
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Afessa B, Greaves W, Green W, Olopoenia L, Delapenha R, Saxinger C, Frederick W. Autopsy findings in HIV-infected inner city patients. J Acquir Immune Defic Syndr 5:132–136, 1992.
Aron DC. Endocrine complications of the acquired immunodeficiency syndrome. Arch Intern Med 149:330–333, 1989.
Bierhoff E, Weiss A, Tschabel K, Pfeiffer U. Epidemiological and pathomorphological autopsy findings in AIDS. Verh Dtsch Ges Pathol 75:163–165, 1991.
Bloom BR, Murray CJL. Tuberculosis: commentary on a reemergent killer. Science 257:1055–1063, 1992.
Bricaire F, Marche C, Zoubi D, Perronne C, Matheron S, Rouveix E, Vittecoq D. Adrenal lesions in AIDS: anatomopathological study. Ann Med Intern (Paris) 138: 607–609, 1987.
Cote RJ, Rosenblum M, Telzak EE, May M, Unger PD, Cartun RW. DisseminatedPneumocystis carinii infection causing extrapulmonary organ failure; clinical, pathologic, and immunohistochemical analysis. Mod Pathol 3:25–30, 1990.
Dekker A, Oehrle JS. Hyaline globules of the adrenal medulla of man. Arch Pathol 91:353–364, 1971.
Drew WL. Cytomegalovirus infection in patients with AIDS. J Infect Dis 158:449–456, 1988.
Elansary EH, Earis JE. Rifampicin and adrenal crisis. Br Med J 286:1861–1862, 1983.
Falk S, Schmidts HL, Muller H, Berger K, Schneider M, Schlofe W, Helm EB, Stille W, Hiibner K, Stutte HJ. Autopsy findings in AIDS—a histopathological analysis of fifty cases. Klin Wochenschr 65:654–663, 1987.
Giampalmo A, Bodini A, Carli F, Castellaneta A, Paladino B, Quaglia AL. Patologia del surrene et del ipofisi nell AIDS. Pathologica 82:527–530, 1990.
Glasgow BJ, Steinsapir KD, Anders K, Layfield LJ. Adrenal pathology in the acquired immune deficiency syndrome. Am J Clin Pathol 84:594–597, 1985.
Groll A, Schneider M, Althoff PH, Falkenbach A, Helm EB, Keul HG, Schleiblinger S, Hubner K. The morphology and clinical significance of pathologic changes of the adrenal glands and hypophysis in AIDS. Dtsch Med Wochenschr 115:483–488, 1990.
Guarda LA, Luna MA, Smith L, Mausell PWA, Gyorkcy F, Roca AN. Acquired immune deficiency syndrome: postmortem findings. Am J Clin Pathol 81:549–557, 1984.
Guenther EE, Rabinowe SL, van Niel A, Naftilan A, Dluhy RG. Primary Addison’s disease in a patient with the acquired immunodeficiency syndrome. Ann Intern Med 100:847–848, 1984.
Guy RJC, Turberg Y, Davidson RN, Finnerty G, Mac Gregor GA, Wise PH. Mineralocorticoid deficiency in HIV infection. Br Med J 298:496–497, 1989.
Hart MN, Cyrus A. Hyaline globules of the adrenal medulla. Am J Clin Pathol 49:387–391, 1968.
Hui AN, Koss MN, Meyer PR. Necropsy findings in acquired immunodeficiency syndrome: a comparison of premortem diagnoses with postmortem findings. Hum Pathol 15:670–676, 1984.
Johnson PC, Khardom N, Naijar AF, Butt F, Mansell PW, Sarosi GA. Progressive disseminated histoplasmosis in patients with acquired immunodeficiency syndrome. Am J Med 85:152–158, 1988.
Klatt EC, Jensen DF, Meyer PR. Pathologyof Mycobacterium avium-intracellulare infection in acquired immunodeficiency syndrome. Hum Pathol 18:709–714, 1987.
Klatt EC, Shibata D. Cytomegalovirus infection of the acquired immunodeficiency syndrome. Clinical and autopsy findings. Arch Pathol Lab Med 112:540–544, 1988.
Laulund S, Visfeldt J, Kliuken L. Pathoanatomical studies in patients dying of AIDS. Acta Pathol Microbiol Immunol Scand (A) 94:201–211, 1986.
Loureiro C, Gill PS, Meyer PR, Rhodes R, Rarick MU, Levine AM. Autopsy findings in AIDS-related lymphoma. Cancer 62: 735–739, 1988.
Macher AM, Reichcrt CH, Straus SE, Longo DL, Farrillo J, Lane C, Fauci AS. Death in the AIDS patients: role of cytomegalovirus. N Engl J Med 309:1454, 1983.
Mcmbrano L, Irony I, Dere W, Klein R, Biglieri EG, Cobb E. Adrcnocortical function in acquired immunodeficiency syndrome. J Clin Endocrinol Metab 65:482–487, 1987.
Miller-Catchpolc R, Variakojis D, Anastasi J, Abrahams C. The Chicago AIDS autopsy study: opportunistic infections, neoplasms, and findings, from selected organ systems with a comparison to national data. Chicago Associated Pathologists. Mod Fathol 2:277–294, 1989.
Mobley K, Rotterdam HZ, Lerner CW, Tapper ML. Autopsy findings in the acquired immunodeficiency syndrome. Pathol Annu 20(1):45–60, 1985.
Moskowitz LB, Henslcy GT, Gould EW, Weiss SD. Frequency and anatomic distribution of lymphadenopathic Kaposi’s sarcoma in the acquired immunodeficiency syndrome. Hum Pathol 16:447–456, 1985.
Mulhall BP, Fieldhouse S, Deam D. Adrenocortical lesions and HIV infection. Lancet 1:1345, 1988.
Niedt GW, Schinella RA. Acquired immunodeficiency syndrome. Clinicopathologic study of 56 autopsies. Arch Pathol Lab Med 109:727–734, 1985.
Nunez EA, Christeff N, Benassayag C, Martin ME, Vallette G. Corticosteroid modifications in HIV infection: a role for nonesterified fatty acids. AIDS Res Hum Rctrovir 6:1147, 1990.
Pont A, Williams PL, Loose DS, Feldman D, Reitz RE, Bochra C, Stevens DA. Ketoconazole blocks adrenal steroid synthesis. Ann Intern Med 97:370–372, 1982.
Pulakhandam U, Dincsoy HP. Cytomegalovirus adrenalitis and adrenal insufficiency in AIDS. Am J Clin Pathol 93:651–656, 1990.
Reichert CM, O’Leary TJ, Levens DL, Simrell CS, Macher AM. Autopsy pathology in the acquired immunedeficiency syndrome. Am J Pathol 112:357–382, 1983.
Schlienger JL. Consequences endocriniennes de I’infection par le virus de l’immunodeficience humaine (VIH). Pathol Biol 37: 921–926, 1989.
Schmidts HL, Falk S, Hubner K. Zytomegalo-Infektionen bei AIDS. Dtsch Med Wochenschr 110:818, 1985.
Schneiderman H, Caplan M, Rahman Z, Jones T. Multiplicity of causes for adrenal damage in AIDS. Mt Sinai J Med 54:194, 1987.
Shanley JD, Pesanti EL. Adrenal gland lesions with murine cytomegalovirus. Ann Intern Med 100:765–766, 1984.
Shapshak P, Sun NCJ, Rcsnick L, Thornwaite JT, Schiller P, Yoshioka M, Svenningsson A, Tourtellotte WW, Imagawa D. HIV-1 propagates in human neuroblastoma cells. J Acquir Immune Defic Syndr 4:228–237, 1991.
Shimizu E, Tsujimoto M, Nakamine H, Ohta K, Takcnaka T. Acquired immunodeficiency syndrome (AIDS) with cytomegalovirus adrenalitis andPncumocystis carinii pneumonia. Rimsho Ketsueki 29:711–717, 1988.
Stein CA, Saville W, Yarchoan R, Broder S, Gelmann EP. Suramin and function of the adrenal cortex. Ann Intern Med 104:286–287, 1986.
Tapper ML, Rotterdam HZ, Lerner CW, Alkhafaji K, Seitzman PA. Adrenal necrosis in the acquired immunodeficiency syndrome. Ann Intern Med 100:239–241, 1984.
Telzak EE, Cote RJ, Gold JW, Campbell SW, Armstrong D. ExtrapulmonaryPneumocystisi cariniii infections. Rev Infect Dis 12:380–386, 1990.
Unger PD, Roscnblum M, Krown SE. DisseminatedPneumocystis carinii infection in a patient with acquired immunodeficiency syndrome. Hum Pathol 19:113–116, 1988.
Verges B, Chavanet P, Desgres J, Vaillant G, Waldner A, Braun JM, Patelat R. Adrenal function in HIV infected patients. Acta Endocrinol (Copcnh) 121:633–637, 1989.
Weiss CD. The human immunodeficiency virus and the adrenal medulla. Ann Intern Med 105:300, 1986.
Welch K, Finkbciner W, Alpers CE, Blumenfeld W, Davis RL, Smuckler EA, Beckstead JH. Autopsy findings in the acquired immunodeficiency syndrome. JAMA 252: 1152–1159, 1984.
Wilkes MS, Jacob S, Milberg J, Stoneburner R. Autopsy patterns in patients dying of acquired immunodeficiency syndrome in New York City. Arch Pathol Lab Med 112:1221–1223, 1988.
Wissner Greene L, Cole W, Greene JB, Levy B, Louie E, Raphael B, Waitkevicz J, Blum H. Adrenal insufficiency as a complication of the acquired immunodeficiency syndrome. Ann Intern Med 101:497–498, 1984.
Yang GC, Schinella RA. The histopathology of tuberculosis in the acquired immunodeficiency syndrome: a study of nine cases. In: Rotterdam H, Racz P, Greco MA, Cockerell CJ, eds. Progress in AIDS pathology, vol II. New York: Field and Wood Medical Publishers, 1990:103–110.
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Rotterdam, H., Dembitzer, F. The adrenal gland in AIDS. Endocr Pathol 4, 4–14 (1993). https://doi.org/10.1007/BF02914483
- Adrenal Gland
- Adrenal Insufficiency
- Adrenal Medulla
- Acquire Immunodeficiency Syndrome