Adrenal medullary hyperplasia is an infrequent condition that often presents with hypertension.

Adrenal medullary hyperplasia may be a precursor to pheochromocytoma in MEN2 or germline mutations.


Clinical features:

(1) resistant hypertension with or without recurrent hypertensive crises

(2) suspected pheochromocytoma


Imaging studies show diffusely increased metabolic activity in both adrenal glands.


Examination of the adrenal gland shows:

(1) diffuse expansion of the adrenal medulla into the tail and the two alae of the gland with or without nodule formation.

(2) increased medulla to cortex ratio

(3) increased calculated medullary weight

(4) enlarged cells with or without pleomorphism


Resection of the hyperplastic adrenal gland improves blood pressure control.

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