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Volume and cortico-medullary ratio of the adult human suprarenal gland.

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VOLUAIE AKD CORTICO-AIEDVLLBRT RATIO O F THE
ADULT HUMAN SUPRARESAL GLAND
C . A. SWISYAIID
Dcparttwiit o f A n a t o m y , Xedzcal College of the S t a t e of Sozitti Carolina, Chcirleston
ONE FIGCRE
Although there is considerable quantitative data regarding
the volume and cortico-medullary ratio of the adrenal glands
of lower animals there is insufficient information of this
nature concerning the human suprarenal glands. The only
quantitative volumetric study of the human suprarenals we
have been able to find is that of TIammar ( '24) who computed
the volume and cortico-medullary ratio of ten unselected
suprarenal glands using a volumetric method previously described by hini (Hammar, '14). That there is need for additional data on the human gland is indicated by the quantitative
relation of suprarenal cortical tissue to Addison's disease
(Wilder, '38; Snell and Rowntree, '29) and to the adrenogenital and Cushing's syndromes (Broster, '37 ; Haymaker
and Anderson, '38).
I n the numerous reports concerning hypertrophy and
atrophy of the cortex of the human suprarenal gland in different physiological and pathological states, almost without
exception no information regarding the method of determining
the size is given. It must be assumed that the question is
decided by the weight of the entire gland o r only casual inspection of the gland at autopsy and study of several hematoxylin eosin sections. According to Grollman ('36) it is
extremely difficult to estimate the size of the adrenal medulla
by simple examination at autopsy. Clark and Rowntree ( '34)
studied the hematosylin eosin sections made routinely from
511 pathologic cases and experienced great difficulty in confirming a previous diagnosis of 11;-pertrophy or atrophy.
69
70
C. A. S W I N Y A R D
They found oiily four cases of cortical hypertrophy aiid in
these there was no mention of symptoms in the clinical record.
Seven cases of cortical atrophy were noted, in five of which
emaciation and weakness mere indicated in tlie record. Nine
cases of medullary enlargement were fo~iiid,in two of ~vhicha
clinical diagnosis of malignant hypertension had been made.
The clinical record of the other seven showed no evidence of
paroxysmal hypertension.
Quotations regarding the weights of the humaii suprarenal
glands taken from four commonlv used textbooks of anatomy
arc) given below:
3lorris ( ’33) ‘‘Tlie neiglit of tlie glands is given f i o m I t o 18 g m ~ n sand is liable
to coiisiderable physiological nn4:ition. ”
Gray ( ’36) “Their average weight is from I..? gin. t o 2.5 gi’ams each.”
Cunningham ( ’31) “ weight about 7-12’ grams. ’ ’
Piersol ( ’30) “ They weigh six or Seven grams. ”
In view of the above it is iiot surprising that there a r e diffwences of opinion regarding the size of the normal glands.
What iiiay appear to be a slight hypertrophy to one observer
map well be a noriiial gland in the light of another observer’s
experience. Jackson ( ’13) found moderate variability and
only a low coefficient of correlation with bodp weight in the
1.a t adrenal.
The volume aiid coi.tico-iiiedullary ratio of the absolutely
normal humaii suprarenal gland can be obtained only from
fresh oi*gans in cases of sudden accidental death in which
autopsy reveals no significant pathology. This gland rapidly
nndergoes autolytic changes after death. Grollman ( ’36)
believes that the changes in the suprarenal glands in infections are confined largely to the cortex and that many of the
histological pictures described in the suprarenals as characteristic of certain diseases a r e actually post mortem autolytic
changes. Hoerr (’31) has found that the slightest pressure on
tlie guinea pig gland will introduce changes in the microscopic
picture. Cowie ( ’19) and MacKenzie ( ’22) observed focal
necrosis, hemorrhage, edema, and cloudy smelling in the cortex
of the suprarenals in acute 1)acterial toxemias. None of these
VOLUMETRIC STUDY O F HUAIAX SUP1;AREXALS
71
changes were shown in the glands considered here.l However,
even though the glands appear to be histologically normal it
is not improbable that they may have undergone unrecognized hypertrophy or atrophy. There a r e clear-cut cases of
suprarenal hypertrophy associated with infections, a s i n the
case reported by Broster and Vines ( '33), in which the adrenals
of a n 8-month-old infant dying of acute enteritis weighed
16.5 gm. Nevertheless, many of the reports of slight hypertrophy or atrophy are not based on sufficiently accurate
determination and some of the routine autopsy records a r e
not reliable. Thus there a r e a number of accounts in which
the dimensions given a r e certainly within normal limits while
the weight of the same suprarenal may be given a s 25 or 30
g-m. I n such cases the extraneous fat and connective tissue
probably was not completely removed. The f a t and connective tissue may u7eigl1 twice as much as the gland itself.
I n final analysis, the actual response of the human suprarenal
glands to different physiological and pathological states mill
not be clearly understood until mere estimation gives way to
accurate quantitative and cytological study such a s are used by
Rasmussen ('28, '36) and Severinghaus ( '33) on the 1iypophTsis. A volumetric method applicable to the human suprarenal
is here describecl.
M A l ' E R I B L AND METHODS
Due to the laborious and expensive methods necessary i n
volumetric computation only small numbers of glands have
been used in studies of this kind. Of the ten human glands computed by Hammar ( '24) only one female and five male glands
fall within the age group reported here.
We have selected for this study, twenty-six histologically
normal appearing suprarenal glands f rom individuals dying
from a variety of causes (table 2). Although the body weight
of the individuals was not available, only glands from persons
I wish t o express my npprcciation to the members of the department of
pathology of this institution f o r providing the glands and studying the sections
f o r pathological signs.
72
c.
A. sw1xYAl:I)
of approximately iiorinal weight were used. The cases i.angecl
from 20 to 57 years of age. I n niost cases paired glands were
used, but in some iiistaiices particularly in the white females,
only one gland was available. I n tliese individuals the riglit
gland was used. The left gland is usually slightlj- larger than
the right hence the sex and racial differences a r e not exaggerated by size disparity in the right and left glands. Donaldson ( '19) found the left adrenal to be heavier than the right
gland in the rat. Baker ('37) found no significant difference
in the size of the right and left adrenal of the dog.
All glands were carefully cleaned of extraneous connective
tissue and fat and were weighed to 0.1 iiig. on an analytical
balance. The specific gravity of the tissue was obtained by
the suspension method, Swinyard ( '39). The true volume of
the fresh gland was then obtained by dividing the weiglit by
the specific gravity. The glands were then fixed in formalin,
dehydrated in dioxan, enibedded in paraffin and serially sectioned at 20 p. Every fiftieth section was mounted and stained
with heiriatoxylin and eosin. The sections were projected at
ten diameters enlargement and the outline of the cortex,
cortical zones and medulla were drawn on heavy paper. The
area of the projected sections was measured with a planimeter.
There is a minimal number of sections which must be measured to assure sufficient accuracy, therefore in two glands
every tenth section was mounted and the volume computation
made by grouping the sections so that the volume was determined by use of blocks of tissue which varied from 0.2 mni. to
2.0 mm. in thickness. The greatest difference in volume obtained by using these interrupted series amounted to 2.7p.
The use of a 0.2 mm. interval (every tenth section) resulted
i n about 250 sections per gland while a 2.0 mm. interval resulted in about twenty-five sections per gland. The interval
used in determining the volume of the glands reported here
was not more than 0.8 mm. and required mounting and drawing of fifty to eighty sections per gland. The difference in
volumes obtained by measuring fifty sections per gland and
that obtained by measuring 250 sections p e r gland was only
VOLUMETItIC STUDY O F €€ UMAN SUPI:AEtEKhLS
73
0.1% , therefore fewer sections could be used with reasonable
accuracy. The computed volumes were augmented to correspond to the true volume (obtained from weight and specific
gravity) in order to conipensatc for the shrinkage mhicli
ovcurred.
O D S E R V A T I O S S A S D DISCITSSION
A summary of the data thus obtained (table 1, fig. 1)indicates that the average volume of the suprarenal gland in the
white male amounts to 5473.4 cu.mm., as compared with 6089.0
cu.nini. f or the white female. Tlie corresponding figures for
negroes are, respectively, 4172.4 cu.mm. and 4413.3 cu.mm.
Converting these figures into percentage form, it appears that
the average volume of the gland in white females exceeds that
of the white male by 10.1%, t h a t of the negro female by 19.3%
and that of the male negro by 31.4%. The suprarenal glands
of the female a r e thus significantly larger than those of the
male in both whites and negroes, and those of the white race
a r e larger than those of the negro race.
I n these same specimens the medulla averaged 435.9 cu.mm.
in the white male, 295.8 cu.mm. in the white female, 464.9
cu.mm. in the negro male and 286.0 cu.mm. in the negro female
(table 1, fig. 1). As the average total volume of the gland
u7as 25.7% greater in whites than in negroes, and the medulla
of the white race averaged 2.6% less than the medulla in the
negro, the larger gland of the white individual may, therefore,
be attributed to the greater amount of cortical tissue. Also
since the total gland is larger and the medulla is smaller in
the female sex of both races it follows that the larger gland
of the female is due, both relatively and absolutely, to the
greater amount of cortical tissue. The percentage of cortex
in the whole gland is likewise greater in the female of both
races (fig. 1). The average cortico-medullary ratio of the
two races and sexes is a s follows: white males 12.4 to 1,
white females 20.4 to 1,negro males 8.3 to 1and negro females
14.2 to 1.
rp
-l
I
26
21
22
23
24
25
26
40
49
4R
40
26
40
Average
17
18
-<It>
43
19
20
~
20
20
38
38
48
48
-.)a
9
21
29
31
31
30
30
33
.
13
14
13
1G
~~
Average 1
-
TABIAE 1
~
-
-
I ;
i
',
.
.
._
.
L
1,
R
R
1,
Ti
R
I,
r,
R
r,
R
I,
I,
R
It
I,
R
R
R
L
R
~
I
.
2985.8
2750.7
5510.0
5960.3
xi0.n
4940.5
4592.8
4331.9
3075.4
3550.3
--c
. ) I 40.1
614.5.2
35.50.0
3375.7
4303.4
4885.2
~
7265.2
6815.3
6 3 2 1.1
(iL'23.4
G3.53.7
6365.1
4900.1
8n4o.o
5Gi0.0
5870.1
5040.3
5190.2
4300.7
5681.8
I
1
2843.6
2619.6
5306.6
5739.9
5211.2
j 4759.7
1 4413.4
,
4172.4
2963.8
3420.3
3558 .0
.59 19.6
3419.2
3249.5
4144.1
4704.8
G5G.i.l
6089.0
4720.5
6132.1
5997.2
6122.3
6997.2
467..?
3,582
628.8
576.8
336.7
247.8
435.9
7 74.5.6
5442.7
5654.0
48.i.i. 1
4999.3
4143.7
5473.4
~
i
eu.?nm.
~
c 1 1. ? r i m .
223.6
201.6
327.3
391.3
320.7
2.71.9
__
286.0.
464.9
619.0
490.7
379.1
1I
~
~
1
-
8.3: 1
2619.9
11.7: 1
444.0
2m.n
I 1.9 : 1
4979.3
1-52: 1
5348.1
13.6: 1
4890.4 , 1.i.2: 1
4.507.7 I _ - 17.8: 1
___
-4127.2
14.2: - 1- 436.5-1
__
.__
3707.3
4.2: 1
7.4: 1
11.4 : 1
_.__
2629.6
3653.3
4325.7
Negro, male glaiitls
348.8
2614.9
7.4: 1
401.5
3018.8
7.5: 1
482.1
5075.9
10.5: 1
5.i29.0
14.1 : 1
;?I.?
72T8.0
1.i.5: 1
875.8
' 5084.5
14.1 : 1
766.0
c502t5..5
7.9: 1
4277.8
7.4: 1
4662.0
13.8: 1
3893.9
15.7 : 1 5037.2
12.4: 1
820.9
White, female 1 inds
331.3 I 4380.3
13.2-: 1 - I 871.9-273.3 ' 5858.8
31.4: 1
.m:; 28.3: 1 '
u*).).J
22.9: 1
s39.1
406.8 I (i589.8
16.2: 1
303.9
6260.3
cii.m?n.
cn.m m.
White, male g
5056.7
4392.0
1850.3
177,5..5
I 1925.2
I
.
3216.2-
--
I
6015.2
4098.3
cii ,111m
'
1
~
303.3
94.7
92.1
92.3
93.8
93.1
93.8
88.0
88.2
88.2
91.3
93.4
82.2
80.9
88.1
91.9
-~
92.8
9Ti.5
96.6
9.5.8
94.1
9.3.3 95.0
-~
_ _ __
231.8
93.3
25n.4
213.2
615.4
200.9
- ~ -
,
%
93.9
93.4
88.8
88.1
93.2
94.0
91.9
I*oliittie mid cortico-iiictiullar~ ratio of ?tiale and f e m a l e , ncgro and white IriiitLan suprarenal glaads
~~
7.8
7.6
6.1
6.8
6.1
5.3
6.6
11.9
11.7
11.7
8.6
6.5
17.7
19.0
11.8
8.0
7.1
4.4
3.4
4.1
.5.8
4.6
4.9
--
~~
11.1
11.8
6.7
5.9
8.0
%
6.0
6.5
TOLUMETTtIC STUDY O F H U M A N SUPRABENALS
75
Turning now to tlie layers of the cortex, it was found that
in six glands (table 1, fig. 1) the zona glomerulosa averaged
l5.0%, the zona fascicnlata 78.4% and the zoiia reticularis
6.4% of the total cortical volume. The volume of the cortical
CU.MM.
7000
6500$
a
MEDULLA
a
CORTEX
m
S I J
WHITE
%
$
NEGRO
BOTH SEXES
WHITE
NEGRO
Fig. 1 Graphic representation i n cubic milliineters of the total volume,
cortical volume and medullary volume of male and female white and negro
suprarenal glands. The percentages in the columns combining the sexes represent
the proportion of the cortical zones t o the total cortical volume while in the other
columns they indicate the proportion of cortex t o the total volume of the gland.
Z.G. = zona glomerulosa; Z.F. = zona fasciculata; Z.R. = zona reticularis.
zoiies varied widely, that of the zona reticularis being the most
variable. No significant differences in sex o r race was apparent in the cortical zones of glands in which this measurement was made.
76
C. A. SWINYABD
Hammar ('24) expressed the size of the suprarenal gland
by weight. By applying the average specific gravity of our
glands to the weight of Hammar's five male glands which
fall within our age group, the total volume of his five male
glands is within 3.0% of those reported here. The total volume
of his five male glands averaged 5310.6 cu.mm. The cortex
averaged 4978.7 cu.mm. and the medulla 331.8 cu.mm. The
cortico-medullary ratio was 15.0-1.
The observation that the human female suprarenal gland is
larger than that of the male is in agreement with similar
TABLE 2
Cause of death of the individuals whose suprarenal glands are listed in table 1
1. Lobar pneumonia
2. Pneumonocoecic meningitis
3. Sub-acute bacterial endocarditis
Congenital malformation of aortic
valve
4. Sub-acute bacterial endocarditis
Congenital malformation of aortic
valve
5. Carcinoma of stomach
6 . Carcinoma of stomach
7. Peptic ulcer-gastric hemorrhage
8. Pulmonary embolism
9. Pulmonary embolism
10. Korsakoff 's psychosis
11. Generalized arteriosclerosis. Cardiac
infarction
12. Generalized arteriosclerosis. Cardiac
infarction
13. Stab wound of chest
14. Stab wound of chest
15. Malignant nephrosclerosis
1G. Malignant nephrosclerosis
17. Pulmonary tuberculosis
18. Pulmonary tuberculosis
19. Carcinoma of stomach
20. Carcinoma of stomach
21. Diabetic coma
22. Diabetic coma
23. Malignant nephrosclerosis
24. Malignant nephrosclerosis
25. Cerebral thrombosis with softening
Z G . Cerebral thrombosis with softening
studies on the rat (Jackson, '13; Hatai, '13) and the dog
(Baker, '37). Jackson ( '19) found the medulla of the newborn
rat suprarenal (in thirty-six animals) constituted about 25.0%
of the gland a t birth, decreasing to 7.0% of the total gland at
10 weeks of age. Donaldson ( '19) noted a similar trend in the
cortico-medullary ratio of the rat (seventeen animals) and
also found that the glands of the female contained relatively
less medulla. Elliott and Tuckett ( '06) studied this problem
in several species of animals and reported the following medullary percentages : Fowl 50.0%' dog 20.0%' cat 5.7%' rat 5.0%'
rabbit 2.5% and guinea pig 1.6%. Their figures were based
VOLUMETRIC STUDY OF H U M A N SUPRAXENALS
77
on two animals for each species. Flint ('00) estimated the
medulla of the dog (in three animals) to be 33.0% of the total
gland. Perhaps the most accurate figures for the dog are those
of Baker ('37) who found the medulla to average 14.3% of
the total gland (in six animals). These figures indicate
the great variability of the suprarenal glands in the higher
vertebrates. Elliott and Tuckett ( '06) suggest that the lower
the animal is in the vertebrate scale the greater is the proportion of the medulla. While our figures do show a sex and
racial difference in the ratio of the two parts of the human
gland we feel that there is insufficient quantitative data to
support their suggestion statistically.
CONCLUSIONS
The figures presented indicate that the suprarenal glands
are significantly larger in the female than in the male sex
in both the white and negro race.
The larger gland of the female is due to the relatively and
absolutely greater amount of cortex in this sex.
The glands of the white race are larger than those of the
negro race. The larger gland in the white race is due to the
absolute greater amount of cortex.
The volume of the medulla is less in the female than in the
male of both negro and white individuals.
The cortico-medullary ratio averages 12.4 to 1in the white
males, 20.4 to 1 in white females, 8.3 to 1 in the negro males
and 14.2 to 1in the negro females.
LlTERATURE CITED
D. D. 1937 Studies of the suprarenal glands of dogs. I. Comparison of
BAKER,
the weights of suprarenal 'glands of mature and immature male
and female dogs. Am. J. Anat., vol. 60, pp. 231-252.
BROSTER,
L. R. 1937 Eight years experienae with the adrenal gland. Arch. of
Surgery, vol. 34, pp. 761-791.
L. R., AND H. W. C. VINES 1933 'The Adrenal Cortex.' London.
BROSTER,
CLARK,J. H., AND L. G . ROWNTREE1934 Studies of the adrenal glands in
health and disease. I. Diseases of the adrenal glands as revealed in
25,000 autopsies. Endocrinology, vol. 18, pp. 256-273.
D. J. 1931 Text-book of Anatomy (6th ed. edited by Arthur
CUNNINGHAM,
Robinson), p. 1321.
78
C. A. SWINYABD
AND P. TV. BEAVEN1919 On the cliiiical elidelice of involvenieiit
of the suprarenal glands in influenza and influenza1 pneumonia. ,4rch.
I n t . Med., vol. 24, pp. 78-88.
I)ONALDSON,
JOHN
C. 1919 The relative volumes of the cortex and medulla of
the adrenal gland in the albino rat. Am. J. Anat., vol. 25, pp. 291-298.
ELLIOTT,T. R., A N D TVOR TUCKETT 1906 Cortex and medulla in the suprarenal
glands. J. Pliysiology, vol. 34, pp. 332-369.
FLINT,J. M. 1900 The blood vessels, angiogenesis, organogcnesis, retieuluin
and histology of thc adrenal. Johns Hopkins Hosp. Rep., vol. 9, pp.
153-23 0.
G R ~ YHENRY
,
1936 Anatomy of the Human Body (23rd ed. edited by W. 11.
Lewis), p. 3267.
GROLLhfAN, ARTHUR 1936 The Bdrenals (monograph). 410 pp. Williams fiWilkins Co., Baltimore.
RATAI,S. 1913 On the weights of the abdominal and the thoracic visceia, tlif
sex glands, ductless glands and the eyeballs of the albino rat according
t o body weight. Am. J. Anat., vol. 15, pp. 87-119.
1914 Methode die Menge der liinde und des Marks der Thymus,
H ~ J I ~ R I J.
~ R A.
,
sowie die Anzahl und die Grosse der Hassalsclien Korper zahlenmassig
festuzustellen. Ztsehr. f . angeivandte Anat. u. Konstitutionslehre, Bd.
1, 8. 311-396.
____ 1924 Reitriige aur Konstitntionsanatomie. V I I I . Methode, die
lfenge des Marks, der Riude und der Rindenzonen, sowie de Menge
nnd Verteilung der Lipoidc der Menschlichen Nebenniere zahlenmassig festzustellen. Ztschr. f . mikr. anat. Forseh., Bd. 1, S. 85-190.
HAYMAKER,
W., A N D EVELYN
ANDERSON 1938 The syndrome arising from
hyperfunction of the adrenal cortex : The adrenogenital and Cushing 's
syndromes--A review. New International Clinics, vol. IV, new series,
pp. 244-299.
.J\CKSOW, C. M. 1913 Postnatal growth and variability of the body and of
the various organs in the albino rat. Am. J. Anat., vol. 15, pp. 1-68.
. __
1919 The postnatal development of the suprarenal gland-and
the
effects of inanition upon its growth and stiucture in the albino rat.
Am. J. Anat., vol. 25, pp. 221-289.
Rf ~ C K E X Z IJ.
E , J. 1922 Pathological anatomy of the adrenals. Endocrinology
and Metabolism, vol. 2, p. 257.
MORUIS,€I. 1933 Human Anatomy (9th ed. edited by C. M. Jackson), p. 1427.
PIERSOL,GEORGEA. 1030 Human Anatomy (9th ed. edited by G. Carl Huber),
p. 1801.
R ~ S ~ I U S S E A.
N , T . 1928 The weight of the principal components of the norm:il
male adult humail hypophysis cerebri. Am. J. Anat., vol. 42, pp. 1-27.
_1936 The proportions of the various subdivisions of the normal
adult humaii hypopliysis cerrhri and the relative number of the
different types of cells in pars distalis, with bioinetric evaluation of
age and sex differences and special consideration of basophilic inrasiou
into the infuiidibular process. Assoc. for Res. in S r i i ous and Mental
Disease, 101. XVII, pp. 118-150.
COTVIE,D. M.,
VOLUMETKIC STUDY O F H U M A N SUI’I:ARESALS
79
SEWRINGHAUS,
A. E. 1933 A cytological study of tlie anterior pituitary of the
rat with special reference t o the Golgi apparatus and to eel1 relatioiiship. Anat. Rec., vol. 57, pp. 149-176.
SNELL,
8 . M., A N D L. G. XOWNTREE1929 Clinical experience with Addison’s
disease. Ann. Int. Med., vol. 3, pp. G-28.
SWINYARD,
C. A. 1939 Methods for volumetric detciniination of fresh endocrine
glands. Anat. Rec., vol. 74, pp. 71-78.
WILDER,RUSSELL 31. 1938 Recent clinical and experimental observations in
ndrennl insufficiency. Kex. Iiiternational Cliiiics, rol. IIT, pi). 1-18.
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