Yu writes regarding our review of reported cases of adrenal medullary hyperplasia (AMH), suggesting that AMH may not be securely diagnosed in all cases due to the subjectiveness of mild clinical symptoms, the nonspecificity of hypertension as a sign, the lack of clearcut tumors in most cases on computed tomography/magnetic resonance imaging, and metaiodobenzylguanidine (MIBG) scanning sometimes revealing only mild asymmetrical uptake (1). The author further proposes that the small extent of abnormal adrenal medullary tissue that may be present is unlikely to result in clinical pathology, as some more apparent pheochromocytomas are not secretory. Yu suggests that AMH is “not a real disorder” and does not justify adrenalectomy.
AMH is histologically defined, and the purpose of the review was to examine the reported clinical correlates of this diagnosis, defined by the World Health Organization (2). We note, of course, that a disconnect between pathological tissue mass and secretory capacity is a characteristic of endocrine tissues. We conclude from our analyses that the clinical, biochemical, and imaging findings, as well as the association with established genetic causes of pheochromocytoma, are all compatible with mild cases of catecholamine excess from chromaffin tissue (3).
Certainly, adrenalectomy based on potential AMH should not be performed. Instead, such a decision should be based on clinical grounds and on the assessment of risk and benefit to the patient. However, a review of the correlates of AMH pathology are in keeping with a real disorder.
Abbreviation
- AMH
adrenal medullary hyperplasia
Contributor Information
Rafal Ganni, School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, NSW 2010, Australia.
David J Torpy, Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Faculty of Medicine, University of Adelaide, Adelaide, SA 5371, Australia.
Henrik Falhammar, Department of Endocrinology, Karolinska University Hospital, SE-17176 Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, SE-17176 Stockholm, Sweden.
R Louise Rushworth, School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, NSW 2010, Australia.
Funding
Magnus Bergvall Foundation (H.F.).
Disclosures
None declared.
References
- 1. Yu R. Letter to the Editor From Yu: “Adrenal Medullary Hyperplasia: A Systematic Review and Meta-analysis”. J Clin Endocrinol Metab. 2023;108(10):e1159–e1160. [DOI] [PubMed] [Google Scholar]
- 2. Lloyd RV, Osamura RY, Kloppel G, Rosai J. WHO Classification of Tumours of Endocrine Organs. Vol 10, 4th ed. International Agency for Research on Cancer; 2017. [Google Scholar]
- 3. Ganni R, Torpy DJ, Falhammar H, Rushworth RL. Adrenal medullary hyperplasia: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2023;108(9):e885–e892. [DOI] [PMC free article] [PubMed] [Google Scholar]
