Primary pigmented nodular adrenocortical disease. A light and electron microscopic study of eight cases

W. D. Travis, M. Tsokos, J. L. Doppman, L. Nieman, G. P. Chrousos, G. B. Cutler, D. L. Loriaux, J. A. Norton

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of Cushing's syndrome, which is adrenocorticotropic hormone-independent and involves both adrenal glands. The characteristic pathological features include multiple pigmented cortical nodules and atrophy of the internodular cortex. The adrenal size ranges from small to normal or slightly enlarged. Review of the gross, light microscopic, and ultrastructural features of eight cases seen at the National Institutes of Health revealed several very unusual findings. We observed the following in our patients: macronodules up to 3.0 cm; microscopic foci of necrosis; mitoses; cortical hyperplasia rather than internodular atrophy; focal confluence of nodules giving a diffuse pattern of cortical involvement, and a focal trabecular growth pattern. The nodules were composed primarily of eosinophilic, lipid-poor cells similar to those of the zona reticularis. However, lipid-rich cells similar to those of the zona fasciculata were also demonstrated in the nodules by both light and electron microscopy. This suggests that the adrenal cortical nodules of PPNAD may be derived from not only the zona reticularis, but also the zona fasciculata.

Original languageEnglish (US)
Pages (from-to)921-930
Number of pages10
JournalAmerican Journal of Surgical Pathology
Issue number11
StatePublished - Jan 1 1989
Externally publishedYes

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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