Age-related Changes in the Adrenal Cortex: Insights and Implications

Abstract

Aging is characterized by a gradual decline in physiological function. This process affects all organs including the adrenal cortex, which normally functions to produce essential steroid hormones including mineralocorticoids, glucocorticoids, and androgens. With increasing age, features such as reduced adrenal cortex size, altered zonation, and increased myeloid immune cell infiltration significantly alter the structure and function of the adrenal cortex. Many of these hallmark features of adrenal cortex aging occur in both males and females, yet are more enhanced in males. Hormonally, a substantial reduction in adrenal androgens is a key feature of aging, which is accompanied by modest changes in aldosterone and cortisol. These hormonal changes are associated with various pathological consequences including impaired immune responses, decreased bone health, and accelerated age-related diseases. One of the most notable changes with adrenal aging is the increased incidence of adrenal tumors, which is sex dimorphic with a higher prevalence in females. Increased adrenal tumorigenesis with age is likely driven by both an increase in genetic mutations as well as remodeling of the tissue microenvironment. Novel anti-aging strategies offer a promising avenue to mitigate adrenal aging and alleviate age-associated pathologies, including adrenal tumors.

Safety of immune checkpoint inhibitors in patients aged over 80 years: a retrospective cohort study

“…Age-related relative adrenocortical dysfunction may result in decreased cortisol production, altered immune status, and elevated eosinophil count [ 28 , 29 ]. Since eosinophil counts reflect decreased adrenocortical function, relative corticosteroid deficiency may increase the incidence of irAEs [ 27 ]. Cortisol levels were not clearly measured in many cases in this study, and it was impossible to correlate cortisol levels with apparent production levels.…”