The Study Of The Ultra-microscopic Pathology In Adrenalcortical Adenoma And Hyperplasia In Conn's Syndrom

Background and ObjectivePrimary aldosteronism is one of the most reason of symptomatic hypertension, recently in hypertensive populations suggested that the prevalence may be 5%～13% in Asia. The most common clinical subtypes of primary aldosteronism are APA and adrenal cortical hyperplasia (or IHA). The patients of APA can be cured by operation. But the patients of IHA should be treated by both drug treatment and operation,and the recurrence rate of IHA is also very high. So the discrimination of these two disease has very important significance in clinic. The clinical manifestation of these two diseases both are high blood pressure, hyperaldosteronemia, and hypokalemic,so it made the clinic diagnos difficultly. At present, we only depend on pathobiology of specimen after operation to discriminate. Because they have highly discrimination in pathology of optical microscope and hormone secretion, we think that the occurrence and the development of these two diseases must be related by different ultrastructure.MethodsThe APA and IHA specimens are divided into two pieces. One is undertaked by the optic-microscope pathology study for pathological diagnosis. Another is made into ultrathin section by draw the materials, fixation, dehydration, soak, embedment, slice and dyeing and so on; then we can get some images by the transmission electron microscopy; at last we can clear the different ultrastructure of these two diseases. In my experiment, these two diseases were compared with the same normal adrenal gland, so we could compare the APA to IHA by using these data. Then,the different ultrastructure of these two diseases is clear.ResultsThe APA,in the histology, the majority of tumor cells are similar to the normal zona glomerulosa or zona fasciculata cells. But in the electron microscope,these cells have the special characters: the plastosome of globular or long and of long tracheid crista, obvious Golgi complex, a heap of parallel disposed rough endoplasmic reticulum, many lipid droplets,obvious lipofuscin granulation, sometimes intranuclear pseudo-inclusion body also can be see. Adrenal cortical hyperplasia cells are mainly abundant of lipidic cellule clear. In the electron microscope, a heap of smooth endoplasmic reticulum and rough endoplasmic reticulum in the hyperplastic cells and tracheid crista plastosome. We thought, plastosome of the adrenal cortex shows a common adaptive function and these aldosterone- producing tumor cells have a mass of lamellar crista of plastosome.Conclusions1. The adrenocortical adenoma, in the optical microscope, most of are hybrid cells: hyaline cell often is the most and another cell also exist. Adrenal cortical hyperplasia, in the optical microscope, has a characteristic of no envelope, sporadic tubercle and bilateral pathological changes.2. The adrenocortical adenoma, in the electron microscope,these cells have the special characters: the plastosome of globular or long and of long tracheid crista, obvious Golgi complex, a heap of parallel disposed rough endoplasmic reticulum, many lipid droplets,obvious lipofuscin granulation, sometimes intranuclear pseudo-inclusion body also can be see. Adrenal cortical hyperplasia cells in the electron microscope, a heap of smooth endoplasmic reticulum and rough endoplasmic reticulum in the hyperplastic cells and tracheid crista plastosome. We thought, plastosome of the adrenal cortex shows a common adaptive function and these aldosterone- producing tumor cells have a mass of lamellar crista of plastosome.3.Transmission electron microscopy can effiectively find out different ultrastructure of the subtypes in primary aldosteronism. It is important significance to investigate the subtypes. It gives us great scientific research information to investigate the diseases.