Study on Morphometry of Adrenal Glands in live fetuses by Ultrasonography

Introduction: Development of adrenal gland is always peculiar as it involves the complex process. It has an intriguing role in the harmonious development of fetus. Ultrasonographic Studies on fetal supra renal glands help in understanding the embryology of Suprarenal glands and are also useful in obstetrics, perinatology and fetopathology. Risk factors associated in the pregnancy like maternal diabetes and hypertension could impair the growth of adrenal glands. The nomograms of adrenal glands observed by ultrasonography are of clinical importance and help us in planning prevention and management of a fetus in high-risk pregnancies. This requires a feasible and repeatable screening test. Objective: To estimate various suprarenal gland measurements such as length, width, thickness, volume, surface area, circumference, thickness of cortex and medulla Materials and methods: Present study conducted with62 live normal human fetuses of different gestational ages ranging from 20 – 40 weeks, through ultrasonographic study using real time 4D and B mode Ge Voluson 730 pro ultra sound macine. Probes used were AB-2-7 Convex 2d abdominal Probe and RABA 4-8 Convex 4D abdominal probe. After obtaining the prior permission from the institutional ethics committee, consent from pregnant woman. Sex of the fetus was not revealed during ultrasonographic study. Fetal parameters of supra-renal gland were recorded and documented. Results: Suprarenal gland length, width, thickness, cortico-medullary thickness, surface area and circumference of both right and left side revealed significant difference (p<0.01). the detailed data analysis was presented in the subsequent headings. Conclusion: The data obtained from this study, may useful to understand the suprarenal morphometry in live fetuses thus the database useful in obstetrics, perinatology and fetopathology.

Neurofibromatosis Type 1 Presenting With Adrenal Pheochromocytoma

Background: Pheochromocytomas & Paragangliomas (PCC/PGL) are amongst the rare endocrine tumours, occurring with an incidence of 0.8 per 100,0001. Though most of them have a benign nature, they are usually hormonally active causing significant cardiovascular morbidity due to the catecholamine secretion. Approximately a third of PCC/PGL have underlying germline mutations including Neurofibromatosis type 1 (NF1). Clinical Case: A 49 year old man was reviewed for symptoms of palpitation, headache, sweating, and blurred vision. physical examination revealed signs of NF1. He had multiple neurofibromas over the skin of the back, chest and neck, café-au-lait spots on the trunk and limbs. Ophthalmology assessment revealed multiple Lisch nodules bilaterally. Urinary catecholamines were significantly elevated. His initial systolic blood pressure was 190/148 mmHg. The patient’s medical history included hypertension that used to be well-controlled with Amlodipine 10 mg and Bisoprolol 5mg. however his blood pressure was harder to control during the past year. Laboratory investigations testing included measurements of urinary fractionated metanephrines which revealed high normetanephrines with a value of 690 nmol/d (N &lt; 240). metanephrines (485 nmol/d: N &lt; 275) and norepinephrines (456 nmol/d: N &lt; 440). Plasma free normetanephrines were 3.20 nmol/L (N &lt;1.20) and free metanephrines 0.4 nmol/L (N &lt; 0.48). CT scan of the abdomen showed a 1.3 x 2.4x 3.9 mass in the left suprarenal gland which showed showed moderate uptake on A meta-iodobenzylguanidine (MIBG) scan. And no evidence of metastases. The patient underwent laparoscopic adrenalectomy of the left suprarenal gland and histopathological examination was confirmatory of pheochromocytoma postoperatively. Conclusion:This is a case demonstrating the association between the germline mutation causing neurofibromatosis type 1 with the rare catecholamine secreting tumour (pheochromocytoma). Reference:1. Lefebvre M, Foulkes WD. Pheochromocytoma and paraganglioma syndromes: genetics and management update. Curr Oncol. 2014;21(1):e8-e17. doi: 10.3747/co.21.1579. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

REVIEW ON MEDOVAHASROTAS AND ITS MOOLSTHANA WITH REFERENCE TO OBESITY INDUCED HYPERTENSION

Excess weight gain, especially when associated with increased visceral adiposity, is a major cause of hypertension accounting 65-75% of total cases of hypertension. Increased renal tubular sodium reabsorption by the impairment in renal pressure natriuresis plays an important role in initiating obesity induced hypertension. The present study conceptually tries to substantiate the relation between moolasthana described for medovahasrotas with reference to the pathology of obesity induced hypertension. The moola explained for medovahasrotas are Kati, Vrikka, Vapavahana and Mamsa (Kidney, Suprarenal gland, Lumbosacral region, Superficial fat) which are the general regions of deposition of visceral fat or meda. The increased meda will hamper the renal pressure natriuresis in mainly three ways: 1)Physical compression of the kidneys by fat in and around kidney. 2)Increased activation of RAAS. 3)Increased SNS activity. Thus, medovaha srotodushti further enhances medodhatudushti (Obesity or Sthoulyata) itself, which in turn destroys the srotomoola. Hence, evidence of inherent relation among medovaha srotas and its respective srotomoola is established. Keywords: Medovahasrotas, Srotomoola, obesity induced hypertension

Histological study of normal human suprarenal gland of different age groups

Background: Adrenal gland is a lifesaving endocrine gland of the human body. Knowledge of normal microscopic anatomy of the Adrenal gland facilitates Pathologists to correlate and make the differential diagnosis of various adrenal glands associated clinical conditions on histopathological examination. Aims and Objective: To study histological features of human adrenal gland in the post-natal period at different ages. Materials and Methods: Present study is conducted with 98 human adrenal glands from 49 unclaimed dead bodies during an autopsy and 22 human adrenal glands from 11 cadavers during routine dissection in S.V Medical College, Tirupati, which were utilized after obtaining consent from the close kith and kin. During the autopsy/dissection, the samples collected were from 2 Years to 64 years of age individuals of both sex with typical external features and divided into three groups. The first group consisted of less than 25 years of age. The second group consists of ages between 26 years to 50 years. The third group included 51 years and above, and all the specimens are processed for histological staining and observed under the microscope. Results: At 2 years well-developed capsule with large vessels and well-differentiated zones of definitive cortex and medulla were identified. The thick muscular coat of the central vein was identified at 20 years. At 36 years & 45 years, cellular architecture in various zones is very well differentiated. At 65 years, the cortico-medullary demarcation was irregular, and vascularity decreased. Conclusion: Histological features of pre-pubertal, adult, and old age group sections helps in the understanding of post-natal changes in the growth of the Suprarenal gland and its functions.

Effect of Short and Long Term Restraint Stress on the Histology of Liver, Kidney and Suprarenal Gland in Albino Mice during Postweaning Period

On exposure to stress and for the sake of survival, cells make adjustments with the changes in their environment to the physiologic needs and non-lethal pathologic injury. When the environmental changes are greater than the capacity of the cell to maintain normal homeostasis the cell undergoes acute cell injury. If the injury or insult is removed on time, or the cell can adapt and withstand the injury, the term reversible injury is applied. The processes of adaptation include decreasing or increasing their size, increasing their number, or changing the pathway of phenotypic differentiation of cells. In the present study, albino mice of postweaning age of BALB C strain (21 days old) were exposed to short term (5 days) and long term (21 days) restraint stress to evaluate any histological changes in the kidney, liver, and suprarenal gland. Mice subjected to long term stress showed in the kidney degeneration of the cells of the glomerulus and the convoluted tubules. In the liver, they showed congested sinusoids and the presence of some fatty change, whereas in the suprarenal gland mice subjected to 21 days of stress showed moderate hypertrophy and hyperplasia of the adrenal cortex with the presence of moderate lipoid deposits when compared to controls. The overall effect on short term stress was mild when compared to exposure to 21 days stress Long term stress causes degeneration in hepatic cells, infiltration in the liver, degeneration of glomerulus, Bowman’s capsule, convoluted tubules in the kidney which could lead to nephrotoxicity. In the suprarenal gland, long term stress induces hypertrophy of the adrenal cortex. These morphological changes can explain the impaired immunity which develops in organisms that are exposed to chronic stress.

Critical Analysis of Mulsthana of Medowaha Srotas

According to Ayurveda dhatus (structural entities) are circulating through a channel known as srotas, these strotas carry dhatu (tissue elements or their constituent) undergoing transformation to their destination. Each srotas has 2 mulasthan (roots), which are different according to various text of Ayurveda. Different Acharyas describe roots of Medowaha srotas differently upto some extent, with this context the exploration of this concept is needed with respect to modern science which is mostly based on Pratyaksha pramana. An Ayurvedic principle, to treat the diseases of respective srotas, root site has to be treated. About medowaha srotas, out of two roots one is “Vrikka” is common in all text, but the second root is different with this context exploration is needed. When we correlate term Vrikka with kidney, we can’t full fill the aspect of Meda (fat) metabolism but if Vrikka is correlates with kidney plus suprarenal gland then we can. In Structure suprarenal gland are attached to kidneys on superior side kidneys and suprarenal glands are made up of same tissue. The diseases of Meda dhatu given by compendia are correlated with diseases of hormone cortisol secreated by suprarenal gland, and cortisol is responsible for fat metabolism. Even suprarenal glands are not described in any text of Ayuurveda. The second roots given by Acharyas are Vapawahan, kati, Mansa and Jatharmeda respectively all these structures are deposited with adipose tissue having adipocyte. During starvation this tissue is metabolized and used for energy. So, these all structures are roots of Medowaha srotas.

Study on the gestational age-related histogenesis of human fetal suprarenal glands

Background: Fetal suprarenal gland consists of three zones. They are the outer definitive zone or neocortex (DZ) that forms adult Zona Glomerulosa (ZG), the centrally located fetal zone and a third transitional zone (TZ) the future adult Zona Fasciculata (ZF) which lies just between the neocortex and fetal zone (FZ). The inner ZF that consists of large eosinophilic cells, and the outer definitive zone (DZ) consists of small, densely packed basophilic cells. As early as in 6th week of gestational Age, pheochromoblasts derived from the neural crest migrate through the fetal cortex to form the medulla at a later stage of development. The medulla unrecognizable as a distinct structure in the suprarenal gland throughout most of the gestation, except for small clusters or nests of chromaffin cells scattered throughout the body of the cortex. Aims and Objective: The study was designed and aimed to understand the early developmental histology of suprarenal gland. Materials and Methods: Study conducted at the Department of Anatomy, SV Medical College, Tirupati, Andhra Pradesh, India. The study was carried out by processing representative samples of fetal suprarenal tissues of 13 weeks, 17 weeks, 24 weeks, 25 weeks and 38 weeks gestational age. While processing, we observed the standard dissection procedure and histopathological tissue processing for the human samples. Results: Peripheral narrower and darker definitive zone or true cortex and an inner wider and lighter fetal zone was observed at 13, 17, 24 weeks with 10x objective. The demarcation between cortex and medulla could be seen clearly at 24 weeks. At 25 weeks capsule is very thick and vascular. A well-differentiated gland tissue with clear demarcation of cortex and medulla and a large central vein was observed. At 38 weeks degeneration of fetal zone with a thick-walled central vein was observed at lower magnification (10x objective) Conclusion: Observations on prenatal microscopic structure and gestational age-related changes in suprarenal glands form the basis for understanding structural changes and a foetal database for the local population.