A 40-year-old woman undergoes adrenalectomy for Conn's syndrome (primary hyperaldosteronism). Histology shows a yellow-coloured adrenal cortical adenoma composed of lipid-laden cells resembling zona fasciculata. The zona glomerulosa cells in primary aldosteronism show which change in the contralateral adrenal gland?

• A Hyperplasia of the zona glomerulosa
• B Atrophy of all three cortical zones
• C No change in the contralateral adrenal cortex
• D Atrophy of the zona glomerulosa ✓

Explanation

In Conn's adenoma (unilateral aldosterone-secreting adenoma), the adenoma autonomously produces aldosterone independent of angiotensin II, causing hyperaldosteronism, hypertension, and hypokalaemia. The resultant suppressed renin-angiotensin system leads to atrophy of the zona glomerulosa in the ipsilateral and contralateral adrenal glands (since angiotensin II is the primary trophic stimulus for the ZG). The zona fasciculata and reticularis remain intact because ACTH stimulation is unaffected. This pattern of ZG atrophy is important for surgical decision-making.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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