Summary
Light and electron microscopic examination of adrenal cortices from 4 cases with classical laboratory and clinical features of Cushing's syndrome was performed. Pathologic examination revealed diffuse adrenal cortical hyperplasia and nodular configuration. The cells were predominantly compact in type. Ultrastructural alterations consisted in swelling of the very numerous mitochondria with a rather empty appearance. The prominent agranular endoplasmic reticulum shows various degrees of dilatation. The lipid vaculoes are reduced in number. There is a close structural relationship between lipid vacuoles and mitochondria with fusion of membranes and discontinuity of membranes in some occasions. The cells with numerous lipid vaculoes resemble normal cells of the outer zona fasciculata. In the second case there was an association of Cushing's syndrome with an increased production of aldosterone and androgens. Ultrastructural changes in this case were thick walled intra-mitochondrial tubules and whorled membranous structures of the agranular endoplasmic reticulum. These are considered as morphological equivalents to altered hormonal function of the adrenal cortex.
Zusammenfassung
Vier Fälle eines gesicherten Cushing-Syndroms wurden licht- und elektronenmikroskopisch untersucht. Die diffus verbreiterte Nebennierenrinde oder die Noduli waren überwiegend aus kompakten Zellen aufgebaut. Die Veränderungen an den Mitochondrien, dem endoplasmatischen Reticulum und den Liposomen entsprachen Befunden, wie sie auch tierexperimentell nach ACTH-Stimulation beschrieben wurden. Die Mitochondrien zeigen eine Vermehrung und Schwellung mit Rarefizierung der Innenstrukturen, das glatte endoplasmatische Reticulum eine vesiculäre Transformation, die Lipidvacuolen eine Verringerung. Außerdem bestehen sehr enge räumliche Beziehungen zwischen den Lipidvacuolen und den Mitochondrien bis hin zur unmittelbaren Einbeziehung in das Mitochondrieninternum. Die lipidreichen spongiocytären Zellen der äußeren Rinde ergeben weitgehend das Bild normaler Fasciculatazellen. Darüber hinaus waren in einem Fall mit gleichzeitig nachgewiesener gesteigerter Aldosteron- und Androgenausscheidung auch ultrastrukturelle Besonderheiten in Form elektronendichter paralleler mitochondrialer Innenstrukturen und dichter geordneter Lamellen des endoplasmatischen Reticulum zu verzeichnen. Dieser Befund wird als ultrastrukturelles Äquivalent einer besonderen hormonalen Funktion der Nebennierenrinde interpretiert.
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Mitschke, H., Saeger, W. & Donath, K. Zur Ultrastruktur der Nebenniere beim Cushing-Syndrom. Virchows Arch. Abt. A Path. Anat. 353, 234–247 (1971). https://doi.org/10.1007/BF00545732
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DOI: https://doi.org/10.1007/BF00545732