Paper - Some notes on the early adrenals
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Some Notes on the Early Adrenals
By Dr M. S. Honan
Work done at the Mayo Clinic, Rochester, U.S.A.
IN the adrenal of a new-born baby, the cortex consists of two layers, namely, an outer thin zone _of tissue that is mainly basophilic in staining character, and an inner zone of greater width that is mainly eosinophilic. Because of these staining qualities the outer zone has a bluish tinge when stained by haemotoxylin and eosin, and the inner zone, when similarly stained, is of a pink colour. The outer zone is called the “adult cortex,” and the inner zone is called the “foetal cortex.”
In 1911 Armour and Elliott drew attention to these two layers in the adrenal cortex of the new-born babe, and noticed that soon after birth the adult cortex begins to grow, while the foetal cortex begins to degenerate. In 1926 Lewis and Pappenheimer expressed the belief that these post-natal changes were in no way altered even if the child were born prematurely. In 1927 Lucas, Keene and Hewer reported that the foetal cortex has begun to degenerate even during the last ten weeks of intra-uterine life.
Adrenals were obtained at autopsies from foetuses and infants. Autopsy was performed usually within 12 hours of death. The tissue was fixed in 10 per cent. formalin, and stained with haemotoxylin and eosin. In addition, Van Gieson and Scharlach R. stains were used on many sections. Some of the slides were obtained from amongst those kept on file at the Mayo Clinic since 1923. All the Van Gieson stained slides were made from the paraffin blocks kept on file since 1923. In some cases slides were stained by the methods. of N issl and Orlandi, from the original paraffin blocks. In addition I had permission to examine slides retained in Dr Adair’s department at the University of Minnesota.
In about 10 days after birth a change is seen to take place in both the adult and foetal cortex of the adrenals. The foetal cortex is seen to be replaced slowly by adult cortex. The adult cortex consists of cells whose nuclei are smaller and whose cytoplasm is less abundant than the nuclei and cytoplasm of the cells in the foetal cortex. The arrangement of the cells in the two layers is different, those in the adult cortex tending to form clusters like bunches of grapes. When stained by haemotoxylin and eosin both the cytoplasm and the nuclei of the cells of the adult cortex seemed to stain more deeply than those in the foetal cortex- Various other stains were used, but did not reveal any additional changes. In Table I are shown the relative thickness of the zones of adult and foetal cortex. The ratio has a mean value of about 0-25 at term, but in case numbers 12, 16, 20, and 21 post-natal development has raised the ratio to above unity. See figs. 1 and 2.
The adult cortex seems to make its first appearance at about the middle of the 7th month of intra-uterine life. The adrenals from a still-born infant of 6 months gestation showed no adult cortex, but seemed to consist entirely of foetal cortex. The adult cortex grows only for a short period in the last 6 weeks of intra-uterine life, and then discontinues its growth, so that the relative depth of the adult cortex is the same in full-term infants as in infants of less than 6 weeks prematurity. Within 10 days of birth there are distinct signs that definite growth has recommenced in the adult cortex.
Many writers have drawn attention to the apparent maldevelopment of the adrenals in cases of anencephaly. I have had the opportunity of studying the autopsy reports of a group of anencephalic monsters, and of studying the microscopic slides of some of the adrenals. In several of these cases the adrenals are markedly under weight, as shown in Table II. However there were two cases in which the adrenals were of normal weight. The microscopic slides for these were unsatisfactory. I append more detailed protocols of these two cases. Of the entire group of anencephalic monsters, the microscopic slides were unsatisfactory in all except three cases, because post-mortem degeneration and haemorrhage had evidently been present before sections were taken. In three new-born anencephalic monsters, in which cases the microscopic slides were satisfactory, the adult cortex had developed to such a degree as that usually shown by the normal babe at the end of the 3rd week of post-natal life. Evidently this seemingly precocious development took place in utero. Scammon and N afiagas have shown that anencephalic monsters are not the subjects of generalised underdevelopment, but that some parts of the body, such as the upper limbs, undergo excessive and precocious growth.
The question arises as to whether there is a parallelism between the maldevelopment of the brain and the maldevelopment of the adrenals. I examined the autopsy reports, and the microscopic slides of the adrenals, in a number of A cases of hydrocephalus, in which the brain showed signs of pressure atrophy: but the adrenals seemed normal in size and structure. (See Table III.)
fig. 2. Adrenal of babe aged 2 weeks showing band of adult cortex of greater depth than ' at birth (fig. 1). (x 50.)
In 18 premature and normal new-born babes the ratio of the thickness of the adult to the foetal cortex has been found to be about 0-25. In four cases ranging in age from 15 days to 61 days the ratio is shown to have increased from 1 to 3.
The cortex of the suprarenal in the premature child develops in a normal manner as though it were not premature. The rate of growth of the adult cortex and of disappearance of the foetal cortex may be used as a rough estimate of post-natal age.
There are apparently some cases of anencephaly, in which the adrenals are of normal weight; and some cases of anencephaly in which the adult cortex of the adrenals undergoes precocious development in utero.
In a group of cases of hydrocephalus associated with brain atrophy, the adrenals seemed normal in size and structure.
Appendix Two Cases of Anencephaly with Normal Adrenals
Case 1. Female child of white parentage, 8 months gestation, weighing 1800 gm. The eyes are exophthalmic in character. There is marked congestion and cyanosis of the conjunctivae. There is malformation of the head. The scalp, calvarium, dura and dural sinuses are missing. The supra-orbital ridges are prominent. The base of the skull is covered with a reddish granulation-like tissue, but no definite structure can be made out. The fossae of the skull are ﬂattened and there is absence of development of the medulla and cerebellum. The neural arches of the upper six cervical vertebrae have failed to fuse, and there is a triangular shaped deficiency on the dorsum of the neck which is continuous with the defect in the skull. The cervical portion of the spinal cord is poorly developed, but a few nerves in the upper portion can be made out. The remainder of the spinal cord shows no evidence of haemorrhage or trauma. The right adrenal weighs 4-3 gm., and the left 5-6 gm. They are normal in position. The surfaces are congested, and on section the centres are reddish brown in colour.
Case 2. A female weighing 2000 gm. There is absence of the scalp and calvarium, the outer surface of the cranial mass being composed of meninges. On opening this membrane, the tissue underneath is composed of soft reddish material. There is no evidence of any development of the cerebrum or cerebellum. The pituitary is apparently normal: and a few cranial nerves can be made out. There is marked exophthalmos and congestion of the mucous mem brane. The adrenals seem to be normal. I98 » ' M. 8. Hanan
Table I. The Foetal and N eo-N atal Suprarenal'Corte.:v.
Ratio of Foetal age Extra-maternal Adult cortex Foetal cortex adult cortex ’ Case N o. in months age Depth in mm. depth in mm. foetal cortex
1 5-5 1 hour 0- 1-3 0-23
2 6-0 — 0-3 1-3 0-23
3 6-0 6 hours 0-3 1-35 0-22
4 5-5 —— 0-25 1-25 0-2
5 6-5 —— 0-3 1-0 0-3
6 6-5 ——- 0-35 1-5 0-23
7 p 6-5 -— 0-3 1-7 0-17.
8 6-5 2 days 0-25 0-95 0-25
9 6-5 —— 0-3 ' 1-15 0-26 10 6-0 7 days 0-4 1-1 0-36 11 7-0 —— 0-25 1-25 0-2 12 7-0 3 weeks 0-6 0-6 ‘ 1-0 13 7 -0 6 hours 0-3 1-0 0-3 14 8-0 17 hours 0-25 1-4 0-17 15 8-0 ——- 0-2 1-3 0-15 16 8-0 15 days 0-55 0-35 1-5 17 8-5 — 0-3 1-4 0-21 18 9-0 — 0-12 1-5 0-08 19 9-2 —— 0-1 2-2 0-04 20 9-0 20 days 0-85 0-5 1-7 21 9-0 2 months and 0-6 0-2 3-0
11 days 22 6-0 — 0-25 0-9 0-27 Table II. The Suprarenals in Anencephaly. -Weight of Adrenals in gmm. r——--J‘-——‘\ Right Left Total Case No. adrenal adrenal weight Pertinent autopsy findings 1 0-8 0-5 1-3 Gestation was 8 months: anencephaly: craniorhachischiscis: congenital absence of left kidney, pelvis, and ureter. 2 1-0 1-0 2-0 Gestation was 8 months: anencephaly. 3 0-5 0-4 0-9 Gestation was 7-5 months: anencephaly: craniorhachischiscis. 4 1-4 1-8 3-2 Full term infant: anencephaly: craniorhachischiscis. 5 2-0 1-5 3-5 Anencephaly: craniorhachischiscis. 6 1-0 1-0 2-0 Gestation was 8 months: anencephaly: craniorhachischiscis. 7 0-6 0-6 1-2 Anencephaly: craniorhachischiscis Table III. The Suprarenals in Hydrocephalus. Greatest Adrenal Weight in gmm. circumference r————/k _ Total of head in Case N 0. Right Left ‘ Weight Gestation cm. Remarks 1 3-8 3-8 7-6 Term 39 Stillborn 2 4-0 3-5 7-5 ,, — Head is markedly hydrocephalic. Antepartum death 3 4-5 4-0 8-5 ,, 38 Stillborn 4 4-0 3-5 7 -5 ,, 43 Died a few minutes after birth 5 2-5 3-0 5-5 ,, 41 Died one hour after birth 6 4-0 3-5 7 -5 ,, 36 Stillborn 7 2-0 2-0' 4-0 ,, 39 Stillborn 8 Adrenals are fused 5-0 . ,, — Hydrocephalus, horse-shoe kidney Some Notes on the Early Adrenals 199
(1) HARTMAN and MCPHEDRAN (1919). “Postnatal Development of Suprarenal and the effect of inanition upon its growth and structure in Albino Rat.” Am. Journal Anatomy, Philadelphia, XXV, pp. 221-291.
(2) SCAMMON (1925-26). “ Prenatal growth and natal involution of the Human Suprarenal.” Proc. Soc. Exper. Biol. and Med. N.Y. XXIII, pp. 806-811.
(3) MARINE, D. (1922). “Possible inﬂuence of Adrenal involution in new-bom infants on heat production.” J. M etab. Research, Morristown, N.J. II, pp. 329-339.
(4) LUCAS, KEENE, and HEWER (April, 1927). “Development of Human Suprarenal.” Journal of Anatomy (Lond.) LXI, pp. 302-324.
(5) ARMOUR and ELLIOTT (1911). “Development of Adrenal Cortex and Hemicephaly.” Journal Path. and Bact. Xv, pp. 481- . J i
(6) LEWIS and PAPPENHEIMER (1916). “ Involution of Adrenal Cortex.” Journal of Med. Research, XXXIV, pp. 81-91. I
(7) MITSUKURI, K. (1882). “Development of Suprarenals in Mammals.” Quart. Journal Microscopic Science, XXII, pp. 17-29.
(8) NAfiAGAS, J UAN CANCIS (1925). “Anencephaly-comparison with normal fetal growth.” Am. Journal Anatomy, XXXV, no. 3.
Cite this page: Hill, M.A. (2020, January 22) Embryology Paper - Some notes on the early adrenals. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Paper_-_Some_notes_on_the_early_adrenals
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