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Endocrine-skin interactions. Cutaneous manifestations of adrenal disease, pheochromocytomas, carcinoid syndrome, sex hormone excess and deficiency, polyglandular autoimmune syndromes, multiple endocrine neoplasia syndromes, and other miscellaneous disorders.

Endocrinologic disorders occasionally manifest themselves by their associated and/or induced cutaneous abnormalities. In some instances, the initial and most prominent complaints of the patient are related to alterations in the skin, and therefore the dermatologist will at times be the first physician consulted. In this review we describe the cutaneous lesions that occur in patients with Cushing's syndrome, adrenal insufficiency, pheochromocytomas, carcinoid syndrome, sex hormone excess or deficiency, polyglandular autoimmune syndromes, and multiple neoplasia syndromes. Additionally, we discuss the relationship of acanthosis nigricans and xanthomas to endocrinologic disorders and the skin lesions that occur in association with the spotty pigmentation, myxoma, endocrine overactivity syndrome, and the polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes (POEMS) syndrome.

Adrenal Gland Diseases↗

[Diagnosis and treatment of adrenal cysts].

Six patients with adrenal cysts, a rare disease, were treated. Among 5 patients undergoing operations, 4 had pseudocysts and one had epithelial cyst. Most of the patients had no symptoms. B-ultrasonography and CT scanning played a leading role in the diagnosis of the disease. The incidence, etiology, pathological classification and treatment of adrenal cysts are discussed.

Adrenal Gland Diseases↗

Calcified foci at the junction between adrenal cortex and medulla of rhesus monkeys.

The occurrence of calcified foci at the junction of adrenal medulla and cortex in monkeys obtained from toxicity studies during a 10-year period is reported. The survey included reinvestigated adrenal samples from 274 male and 270 female rhesus monkeys and 52 male and 52 female cynomolgus monkeys. The incidence of calcified foci was 46% in male and 45% in female rhesus monkeys, and 6% in male cynomolgus monkeys, while their females did not show the lesion. In male rhesus monkeys, the mean number of foci was 4 for both glands, in females, 2 for the right and 4 for the left one. Initial stages indicated that the lesions develop possibly from focal apoptosis of medulla cells followed by a dystrophic mineralization. No correlation was observed concerning dose groups, test article, study length, testing facility, origin of monkeys, their sex, age, diet or final body weight. The foci of mineralization were dystrophic, species-specific in the rhesus monkey and possibly related to stress. The location of the foci at the cortico-medullary junction, precisely the location of the remnants of the fetal zone, may indicate their origin from this zone.

Adrenal Cortex↗

Sonography of the adrenal glands in chronic disseminated histoplasmosis.

In this retrospective study, the findings on abdominal sonograms in six patients newly diagnosed as having chronic disseminated histoplasmosis are reported. Five of six patients showed bilateral adrenal gland enlargement that was similar in degree from side to side. The most characteristic feature was the maintenance of a triangular shape in five glands and a cylindrical shape in two glands. Four glands had a nonspecific round or oval shape. All sonographic findings correlated well with the computed tomographic (CT) findings on each patient except that CT detected the one enlarged right adrenal gland not demonstrated sonographically. Abdominal sonography may provide the initial important clue to the diagnosis of chronic disseminated histoplasmosis.

Adrenal Gland Diseases↗

Malacoplakia in childhood. Case report with ultrastructural observations and review of the literature.

Malacoplakia involving the adrenal gland and colon was found in a 6-week-old infant. To our knowledge, this is the first reported instance of adrenal involvement and it occurred in the youngest patient described to have malacoplakia. The adrenal gland was the site of a previous hemorrhage. Ultrastructurally, the cytoplasm of the malacoplakia cells contained numerous granular inclusions within which were tetrad-shaped particles resembling ferritin. A thorough search failed to show the presence of any bacteria. Several recent papers have suggested that malacoplakia represents a morphologic manifestation of altered host macrophage response and that Gram-negative enteric bacilli are the usual specific etiologic agents. The pathologic findings in the present case raise the possibility that the lesion in this instance represents an altered macrophage response to extravasated erythrocytes alone or to erythrocytes and bacteria.

Adrenal Cortex↗

Experimental adenovirus infection of the mouse adrenal gland. II. Electron microscopic observations.

A strain of mouse adenovirus, found to have a striking tropism for the weanling mouse adrenal gland, enabled electron microscopic examination of adrenals in various stages of infection. Nucleolar hypertrophy and the successive formation of three types of inclusion bodies in association with nucleoli preceded virion production. Angular crystals of virions formed in the affected nuclei. Virus was released by lysis of nuclear membranes; rapid degeneration of cytoplasmic organelles followed. Rupture of external cell membranes released virus into the extracellular spaces where virions crossed vascular basement membranes to enter endothelial cells. Virions were also phagocytized by inflammatory cells which reentered vascular sinusoids, and by adrenal parenchymal cells. Disruption of virus-laden phagocytic vacuoles in parenchymal cells released virions into the cytoplasm. Typical viral inclusion bodies also formed in vascular endothelial cells and in inflammatory cells, but virion replication was not detected. The possibility that virus directly entered parenchymal cells through the external cell membrane without phagocytosis is discussed.

Adenoviridae Infections↗

[Microcystik change in the outer fetal adrenal cortex in twins (author's transl)].

Adrenal glands from 9 twins, born before the 35th week of pregnancy were examined in order to determine the incidence of microcystic changes in the outer cortex. The lesion was found concordantly in 5 pairs of twins and discordantly in one single pair. One of these twins, discordant for the lesion, died immediately after the delivery, the other one 17 days later. The first child had microcystic changes in the outer cortex while the longer surviving brother was devoid of them. These findings favor the hypothesis that the microcystic change of the outer cortex of fetal adrenal glands is most probably caused by some systemic disorder, which affects simultaneously both twins. The lesions seen to be reversible and/or transient and heal spontaneosly if the child survives.

Adrenal Gland Diseases↗