Diffuse cortical hypertrophy (Figure 5 and Figure 6) often results in pronounced widening of the cortex and overall gland enlargement compared with unaffected normal adrenal glands (Figure 7 and Figure 8).
Cortical hypertrophy (of the zona fasciculata) in rats and mice usually results from elevated levels of adrenocorticotropic hormone (ACTH), which in turn can be elevated due to various causes, such as primary hypothalamic or pituitary disease or decreased glucocorticoid feedback regulation caused by adrenal cortical toxic or degenerative lesions. Diffuse, bilateral, and often prominent hypertrophy in the zona fasciculata can also be a sequela to stress from various causes, a finding that is especially common in rats.
Hypertrophy (and hyperplasia) of zona glomerulosa cells can result from derangements of the renin-angiotensin system that result in elevated angiotensin II.
Whether focal or diffuse, cortical hypertrophy is generally not considered to be a preneoplastic change. However, cortical hypertrophy (increased cell size) and hyperplasia (increased cell numbers) can often be concurrent lesions in the same gland or even in the same focus. Thus, as a practical matter, determining which change is predominant in a given lesion and/or gland can be very difficult. Cortical hypertrophy can also be confused with the cortical cell enlargement that occurs in many cases of cytoplasmic vacuolization.
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