The major part is the zona fasciculata (ZF) with large clear lipid-laden cells arranged in columns from the capsule or ZG to the inner zona reticularis (ZR). It synthesizes the main mineralocorticoid, aldosterone. The zona glomerulosa (ZG) is composed of small angular cells with a high nuclear-cytoplasmic ratio, dispersed focally under the capsule. The cortex comprises 3 zones with characteristic histologic features. The medulla comprises approximately 10% of the total weight and is present in the head and body and focally in the alae. It is divided into head, body, and tail with alae extending laterally. At hospital autopsy the average is 6 g, reflecting the stimulation by adrenocorticotrophic hormone (ACTH) in the stress of terminal illness. The normal adult adrenal gland weighs 4 g at surgical excision or in cases of sudden death. The information coming from investigation of the molecular pathology of adrenal cortical tumors is beginning to provide additional tests for the assessment of malignant potential in diagnosis but the mainstay remains traditional histologic analysis. Objective.-To provide an overview of current knowledge on adrenal cortical development and structure that informs our understanding of genetic diseases of the adrenal cortex and adrenal cortical tumors.ĭata Sources.-Literature review using PubMed via the Endnote bibliography tool.Ĭonclusions.-The understanding of basic developmental and physiologic processes permits a better understanding of diseases of the adrenal cortex. Molecular genetic investigations are providing new information on both pathogenesis of adrenal tumors and basic adrenal development and physiology. It is important to differentiate between benign and malignant lesions as adrenal cortical carcinoma is an aggressive tumor. These are now being identified more commonly in life when the abdomen is scanned for other disease. However, in autopsy series adrenal cortical nodules are found frequently. Context.-In surgical pathology practice adrenal cortical tumors are rare.
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