Acute Transient Stress Induced Adrenal Hypertrophy and Adrenal Medullary Hyperactivity

Abstract

Objectives: Adrenal gland hypertrophy can be related to acute stress with abnormal adrenal function tests. It may not always need treatment. Material and methods: An acute presentation of adrenal gland hypertrophy following an abdominal emergency, with subsequent hypoadrenalism was investigated. Results: Adrenal medullary and cortical function fully recovered without treatment. Conclusions:We postulate that the adrenal glands became enlarged and hypertrophied during an acute stress event, possibly caused by acute adrenal medullary hypersecretion and subsequent cortical hyposecretion. A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present. CT scan remains an important diagnostic tool. LEARNING POINTS• Abnormal adrenocortical function tests and hypertrophy can occur in an acutely ill patient as a stress response.• It is possible to have both hypersecretion and hyposecretion of adrenal hormones.• A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present in an acutely ill patient. KEYWORDS Adrenal gland hypertrophy, transient adrenal insufficiency, reversible adrenal dysfunction, transient adrenal medullary hyperactivity, stress related hypertension. INTRODUCTIONThe adrenal medulla and cortex participate in the response to acute stress

Stress-induced severe transient hypercortisolism with reversible bilateral adrenal enlargement after cardiogenic shock

“…A CT density > 10 HU indicates a low lipid content adenoma and has been correlated with functional adrenal enlargement (9). In addition to our report, there was only one case in humans found in the literature reporting reversible adrenal enlargement with abnormal adrenal function and self-resolution after the acute illness resolved (3). In that case, bilateral adrenal gland enlargement with increased 24-h urine metanephrines levels was incidentally found during acute illness.…”

“…As part of the hypothalamic–pituitary–adrenal (HPA) axis, the adrenal gland is an essential stress-responsive organ and plays a major role in mediating the sympathy–adrenomedullary system ( 1 ). Adrenal gland enlargement after stress has been reported in several animal studies ( 3 ). Animal models evaluating the chronic administration of ACTH have demonstrated augmented adrenal functionality and increased adrenal weight and size, which have been suggested to be mediated by both cellular hypertrophy and hyperplasia in the zona fasciculata ( 2 ).…”

“…In animal studies, very high serum cortisol and ACTH levels associated with significant bilateral adrenal gland enlargement have been reported during major stress events ( 1 , 2 ). Only a few cases with detailed imaging, biochemistry, and management have been reported in humans upon literature search performed on PubMed ( 3 ). We describe a case of massive bilateral adrenal enlargement incidentally found on abdominal imaging during critical illness, which was associated with new-onset nonischemic cardiomyopathy with acute reduction in ejection fraction.…”

Stress-induced urgent conditions in endocrinology

“…Одним з основних чинників, що визначають реакцію у відповідь організму на екстремальний вплив або виниклий патологічний процес, є функціональний стан кори НЗ [27]. Аномальна функція кори НЗ і гіпертрофія можуть виникнути як реакція на стрес.…”