Main Anatomical Diagnosis: Cushings Syndrome secondary to Adrenocortical Adenoma

Autopsy:

Gross:

1. Left adrenal gland weighs 13 grams compared to the right which was 12 grams.

2. Left adrenal gland has a 1cm dark yellow nodule confined in the cortex.

Microscopic:

1. Left adrenal gland showed a well defined nodule adjacent to normal adrenal cortex.

2. The nodule was composed of monomorphic cells with clear to granular cytoplasm arranged in nets and cords.

Basis:

The nodule produces elevated glucocorticoid levels presenting Cushing Syndrome.

Early stage: Hypertension and weight loss

With time: Central pattern of adipose tissue deposition becomes apparent in the form of trunkal obesity, moon facies, and buffalo hump or accumulation of fat in the posterior neck and back. Hypercortisolism causes selective atopy of fast twitch (type 2) myofibers, resulting in decreased muscle mass and proximal limb weakness.

Glucocorticoid induces gluconeogenesis and inhibit the uptake of glucose by the cells with resultant hyperglycemia, glucosemia and polydipsia.

Conditions related to the main diagnosis:1. Obese, middle aged, woman

2. 152cm, 62.25kg; BMI 26.9 (overweight)

3. Round face, buffalo hump

4.Globular abdomen

5. Atopy of lower extremities

6. Hematoma, large ecchymosis

7. Left ventricular hypertrophy

Conditions contributory to the main diagnosis:

Gross:

1. Pleural effusion

2. Ascites

3. Exudates in main bronchi, Heavy lungs

Microscopic:

1. Pulmonary and Extrapulmonary TB

Incidental findings:

Aspergillosis- Left lung showed separated fungal hyphae with acute angle branching pattern.Cause of Death:

Respiratory arrest secondary to pleural effusion caused by TB Pneumonia.