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Hypertension Research Network

Work-packages 5: Adrenal Morphology

WP5. Pathological assessment of adrenal gland morphology using an autopsy-based cohort

Prof. Dr. Zsuzsanna Varga

Morphological changes in the adrenal gland assessed in clinical practice are restricted to gross and microscopical findings, which enable a correlation of clinical parameters to the morphological alterations of the adrenal gland. There is, however, a limited utility of using adrenal gland samples from surgical pathology cohorts, as these specimens in most cases undergo surgery due to an underlying neoplastic disease. To achieve a morphological correlation between adrenal gland alterations and treatment resistant hypertension, a cohort of non-neoplastic adrenal gland specimens is necessary, which cannot be assessed in regular surgical specimens. During autopsy service, however, each post-mortal examination includes the gross and microscopical analysis of the adrenal glands, which in a high percentage of the cases are without any apparent malignant disease. Thus, prospectively collecting a cohort of adrenal glands from routinely performed autopsies will enable a systematic analysis of morphological changes in non-neoplastic adrenal glands in correlation to hypertension and associated co- morbidities. Points to be addressed in this prospective analysis include the gross morphology of cortex and medulla, thickness, zonation and the presence of solitary or multiple nodular structures as well as the exact measurements of adrenal zonation using light microscopy, Hematoxylin-Eosin stained sections as well as immunohistochemistry for specific steroidogenic enzymes.