Pathologic Findings in the Adrenal Glands of Autopsied Patients with Acquired Immunodeficiency Syndrome

Rodrigues, Denise Bertulucci Rocha; Reis, Marlene Antônia dos; Teixeira, Vicente de Paula Antunes; Silva‐Vergara, Mario León; Filho, Dalmo Correia; Adad, Sheila Jorge; Lazo, Javier

doi:10.1078/0344-0338-00180

Cited by 23 publications

(28 citation statements)

References 17 publications

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“…Other infectious diseases, including viral and fungal infections, may also cause chronic primary adrenal insufficiency, particularly in immuno-suppressed patients. For example, morphological evaluation of adrenal glands from 128 autopsied patients with the AIDS identified compromised adrenals in 99.2% of cases, with distinct pathological features and infectious agents [27]. Cytomegalovirus is by far the commonest pathogen involved in adrenal dysfunction in AIDS patients [27,28].…”

Section: Mechanisms Of Glucocorticoid Insufficiencymentioning

confidence: 99%

“…For example, morphological evaluation of adrenal glands from 128 autopsied patients with the AIDS identified compromised adrenals in 99.2% of cases, with distinct pathological features and infectious agents [27]. Cytomegalovirus is by far the commonest pathogen involved in adrenal dysfunction in AIDS patients [27,28]. Finally, genetic disorders, tumoural and nontumoural adrenal infiltration, and bilateral adrenalectomy are less common causes.…”

Section: Mechanisms Of Glucocorticoid Insufficiencymentioning

confidence: 99%

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Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids

2004

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This review describes current knowledge on the mechanisms that underlie glucocorticoid insufficiency in sepsis and the molecular action of glucocorticoids. In patients with severe sepsis, numerous factors predispose to glucocorticoid insufficiency, including drugs, coagulation disorders and inflammatory mediators. These factors may compromise the hypothalamic–pituitary axis (i.e. secondary adrenal insufficiency) or the adrenal glands (i.e. primary adrenal failure), or may impair glucocorticoid access to target cells (i.e. peripheral tissue resistance). Irreversible anatomical damages to the hypothalamus, pituitary, or adrenal glands rarely occur. Conversely, transient functional impairment in hormone synthesis may be a common complication of severe sepsis. Glucocorticoids interact with a specific cytosolic glucocorticoid receptor, which undergoes conformational changes, sheds heat shock proteins and translocates to the nucleus. Glucocorticoids may also interact with membrane binding sites at the surface of the cells. The molecular action of glucocorticoids results in genomic and nongenomic effects. Direct and indirect transcriptional and post-transcriptional effects related to the cytosolic glucocorticoid receptor account for the genomic effects. Nongenomic effects are probably subsequent to cytosolic interaction between the glucocorticoid receptor and proteins, or to interaction between glucocorticoids and specific membrane binding sites.

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Section: Mechanisms Of Glucocorticoid Insufficiencymentioning

confidence: 99%

Section: Mechanisms Of Glucocorticoid Insufficiencymentioning

confidence: 99%

Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids

2004

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“…The presence of adrenal involvement with CMV might have contributed to adrenal insufficiency causing hyponatremia and refractory shock. CMV is the most frequent agent identified in adrenal glands in autopsies of HIV patients [22]. CMV adrenalitis can cause adrenal failure in AIDS even in patients receiving steroids [23,24].…”

Section: Discussionmentioning

confidence: 99%

Multiple and atypical opportunistic infections in a HIV patient with Toxoplasma myocarditis

Bal

Dhooria

Agarwal

et al. 2014

Cardiovascular Pathology

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“…The histopathology and morphologic assessment of the adrenal glands were investigated in 128 autopsied patients who died from AIDS [11]. Interestingly, alteration of the adrenal glands was observed in 99.2% of these decedents with various patterns of disease and different pathogens.…”

Section: Investigatedmentioning

confidence: 99%

“…Interestingly, while adrenalitis may be the sole manifestation, the disease is usually disseminated. CMV typically affects the cortex-medulla junction [11].…”

Section: Investigatedmentioning

confidence: 99%

Sudden Death due to Diseases of the Adrenal Glands and Paraganglia

Visonà¹,

Tajana²,

Osculati³

2017

Clinical Management of Adrenal Tumors

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Coroners and pathologists commonly evaluate unexpected deaths due to diseases of the adrenal glands and paraganglia, which are, unfortunately, not rare in their totality. Although cardiac causes are the main cause of sudden death, endocrine conditions can produce sudden, unexpected deaths that need further investigation, especially in younger patients. This chapter focuses on the issue of sudden death due to diseases involving adrenal glands and paraganglia. The main causes of sudden death due to adrenal gland pathology will be examined, paying particular attention to the pathophysiology of sudden death, macroscopic and microscopic characteristics and their correlation with clinical features. These issues are of great interest, especially considering the clinical impact of sudden death and its rarity among patients with adrenal gland diseases. The forensic pathologist's examination is extremely important in determining the cause of death and findings not clinically observable and can contribute to the improvement of the clinical and surgical approach in treating such patients.

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Pathologic Findings in the Adrenal Glands of Autopsied Patients with Acquired Immunodeficiency Syndrome

Cited by 23 publications

References 17 publications

Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids

Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids

Multiple and atypical opportunistic infections in a HIV patient with Toxoplasma myocarditis

Sudden Death due to Diseases of the Adrenal Glands and Paraganglia

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