ADRENAL CORTICOMEDULLARY JUNCTION NECROSIS - MORPHOLOGIC MARKER FOR HYPOTENSION

There have been many ideas on the pathogenesis of adrenal necrosis to explain forms of adrenal insufficency and hemorrhage. The physical separation of the cortex from medulla of the adrenal gland at autopsy and its association with shock, has led us to the hypothesis that transient hypoperfusion results in necrosis at the cortico-medullary junction (CMJ). In a review of 100 consecutive autopsies, cortico-medullary junction necrosis was correlated with acute tubular necrosis of the kidney and centrilobular necrosis of the liver, lesions compatible with hypoperfusion. Clinical evidence of hypotension and acute renal failure were documented from the clinical summaries of the autopsies and were compared with the occurrence of the three lesions. Adrenal CMJ necrosis was found to occur in 44 per cent of the cases. In 83 per cent of the cases with hypotension or acute renal failure, CMJ necrosis was present, whereas acute tubular necrosis was present in only 76 per cent of those cases. Adrenal cortico-medullary junction necrosis may thus be construed as morphologic evidence of hypotension. © 1979.