The Prepuberal and Puberal Growth of the Adrenal (Adrenarche)

The increase in adrenal weight and structural development of the cortex is studied in 630 pairs of adrenals from children between 1 and 19 years. In the group of cases of sudden death adrenal weight increases from 2 g in the 2nd year of life to 4 g in the 10th year. Adult values are achieved at the end of puberty. There exists a significant correlation between adrenal weight, age and body surface. A sex difference does not exist. In cerebral lesions adrenal weight at any period is highly significantly above that of the group of sudden deaths. The adrenal weights of the group of all other cases, designated as consuming diseases, occupy an intermediate position. The breakdown of the medullary capsule and the development of the zona reticularis are the outstanding features of structural development of adrenal cortex. Focal development of a zona reticularis starts at the age of 5 years, at 8 years it usually is present as a continuous zone. The juvenile reticularis cells have larger nuclei than the cells of the zona fasciculata and show a compact cytoplasm without pigment granules. No signs of increased cell destruction are seen. In stress-situations mitotic figures are found predominantly here. The development of the zona reticularis is considered to be the morphologic equivalent of adrenarche and is brought into relation with production of androgens. In 22 cases we found a delayed adrenarche. In such cases a complete medullary capsule is still found after the 5 th year of life, whereas development of the zona reticularis has not yet started after the 10th year of life. Cerebral lesions and congenital cardiac defects are present in 17 of these 22 cases. In 11 cases an accelerated adrenarche is seen, of these 8 show cerebral lesions. By the age of 3 years the medullary capsule has already disappeared completely and the zona reticularis is beginning to develop. In the majority of these cases gonadarche is disturbed too, congruity between gonadarche and adrenarche does not necessarily have to exist.