Morphological changes in adrenals from victims of suicide in relation to altered apoptosis

Abstract

Endocrine dysfunction may cause psychiatric symptoms and, vice versa, psychiatric diseases may lead to endocrine alterations. The adrenal as the end organ of both the hypothalamic-pituitary-adrenocortical and sympatho-adrenal axes is subject to the functional changes of the stress system. Thus, increased adrenal gland weight was observed previously in victims of violent suicide. This study was designed to analyze the morphological and morphodynamic changes of adrenals from suicide victims. We investigated 30 adrenals obtained from 15 suicide victims using immunohistochemistry and a computerized video system. In addition, apoptosis and cell proliferation were analyzed. We found a significant enlargement of the adrenal cortex to 158.8% (SD = 29.8%, p < 0.01) that was restricted to the two inner zones only (zona reticularis, 161.6 +/- 35.3%; zona fasciculata, 186.4 +/- 34.4%). This increase in adrenocortical size correlated with a decrease in the number of apoptotic cells within the zona fasciculata. In conclusion, these results clearly demonstrate chronic structural adrenal changes in suicide victims. The adrenal gland mirrors the functional changes of the stress system which leaves an imprint on the morphology of the gland.

Expression of corticotropin releasing hormone receptors type I and type II mRNA in suicide victims and controls

“…Individuals who commit suicide frequently suffer from depression and will have an activated HPA axis. 36 In fact, hyperplastic adrenals have been described both in depressed patients and suicide victims, and suicide victims had higher POMC mRNA density per cell and larger corticotrophic cell size than cardiac death victims. [36][37][38] In patients with melancholic depression and anxiety disorders, an increased expression of hypothalamic CRH mRNA has been described and CSF CRH levels are inappropriately elevated for their degree of hypercortisolism.…”

“…36 In fact, hyperplastic adrenals have been described both in depressed patients and suicide victims, and suicide victims had higher POMC mRNA density per cell and larger corticotrophic cell size than cardiac death victims. [36][37][38] In patients with melancholic depression and anxiety disorders, an increased expression of hypothalamic CRH mRNA has been described and CSF CRH levels are inappropriately elevated for their degree of hypercortisolism. 26 However, our results did not demonstrate any significant changes in the quantitative expression of CRH-receptors in pituitaries of suicide victims as compared to controls.…”

A Diagnostic Approach to Adrenal Cortical Lesions

“…Adrenal weight increases with enlargement of ZF and ZR. This is probably a combination of hypertrophy, hyperplasia, and reduced apoptosis [38,39]. Lipid depletion occurs in the ZF in a centrifugal manner.…”

Epigenetic regulation of theglucocorticoid receptorpromoter 17in adult rats

“…26 Similarly, the adrenal glands in MDD and in suicide victims are larger, have an increased adrenal cortex, and an exaggerated cortisol response after ACTH administration. [27][28][29][30] These human observations have led several authors to suggest that peripheral HPA axis elements are responsible for the observed hypercortisolemia in MDD. 27,31,32 Our psychosocial stress paradigm also mirrors the increased stress reactivity of the HPA axis in MDD.…”