Macroscopic and Microscopic examination of adrenal gland in medico legal autopsies

Abstract

Background: Medico legal autopsy are performed to identify the cause of death, time of death, determine or confirm medical diagnosis that remained unknown or unclear prior to the patient’s death. Various histopathological finding not related to the cause of death are observed in the routine histopathological examination of medico legal autopsies. These findings are important learning tools for the pathologist and forensic expert and have imminence academic and research value. Materials & Methods: The adrenals were examined meticulously after removal from the deceased at autopsy to find out any gross abnormalities and the findings were noted in the case record forms. On the day of removal of organ; weight and measurement of the specimen were noted, the adrenals were cut, and carefully opened. Photographs of the specimen were taken accordingly. The specimen was then placed in 10% buffered formalin saline for fixation. After overnight fixation the specimen were examined and parameters noted. Total bilateral adrenalectomy was done. Results: Around 38.7% of autopsy cases were seen to have adrenal lesions. In present study the most common age group was seen to be 31-40 yrs with male(71%) being more than females(29%). Among the adrenal lesions, we found 22.64% cases of adrenal cortical nodule, 16.03% cases of adrenal lymphocyte infiltration, 3.77% cases of adrenal haemorrhage, 1.88% cases of adrenal cortical adenoma and 0.94% cases adrenal myelolipoma. In the present study, incidentally detected adrenal mass found in 2.8% of cases, comprising of adrenal cortical adenoma and myelolipoma, in the age group of above 60 yrs gave some guideline that it is found in aged group and the sex distribution in male and female was 2:1. This study shows that prevalence of adrenal cortical nodule is 22.64%. Prevalence increases with increase of age. So this is an ageing process and number of nodule increase with ageing. In most of the cases multiple nodules were found and at the same time they were mostly bilateral. The present study shows percent of cases of adrenal lymphocyte infiltrate increases with increase of age. It is also an ageing process. Most of the cases were present above 70yr. Conclusion: The compilation of these data from autopsies with major unexpected findings that would have contributed to death emphasizes the importance of incorporating autopsy information into institutional quality care and improvement programmes.