Hyperplasia of the Adrenal Medulla in Hypertension of Children

Abstract

Clinical details are given from two children who died with severe hypertension. In both specimens hyperplasia of the adrenal medulla was found. In one case medullary hyperplasia of the adrenal gland was the only lesion, while in the other pyelonephritis was present also. Medullary hyperplasia should be considered as a disease entity for two reasons: (a) in one of the patients, this was the only lesion found at autopsy to account for the hypertension, and (b) because the hypertension persisted after excision of the ischaemic kidney in the second case. There were two proven cases and one suspected case of medullary hyperplasia in a series of 20 patients exhibiting hypertension (excluding cardiovascular disease and glomerulonephritis). In Case 1 the study of the nephrons by means of microdissection failed to reveal nephron abnormalities which might predispose to development of pyelonephritis. It could be that the hypertension of adrenal origin could have been the predisposing factor in the development of the pyelonephritis in this child. Study of the juxtaglomerular apparatus of Goormaghtigh indicated that pressor substance is probably formed in both the juxtaglomerular bodies and in hypertrophic tubules.