Gross Changes in Adrenal Glands in Suicidal and Sudden Death Cases: A Postmortem Study.

Introduction Chronic stress breaches the normal homeostasis of the hypothalamic-pituitary-adrenal axis, leads to chronic adrenal fatigue, and causes hypertrophy and hyperplasia of the adrenal gland. The current study was carried out with the aim of observing the difference in gross morphological changes in the adrenals of people dying by suicide and from sudden death, as persons committing suicide are exposed to chronic stress (depression), while those dying suddenly are exposed to the acute stress of dying. Materials and methods The present analytical study was carried out in the Department of Forensic Medicine and Toxicology, Gandhi Medical College, Bhopal, India, after approval from the Institutional Ethics Committee (IEC). A total of 100 established cases of suicide with prominent autopsy findings and relevant history without signs of decomposition, aged 15-60 years, irrespective of gender, and a variable survival period (immediate death to within 24 hours) were selected. A total of 20 controls included those who died suddenly from an act other than suicide within 24 hours of the incident. Due consent was obtained from the relatives and police in the prescribed proforma. Kidneys, along with peri-renal fat and adrenal glands on both sides, were carefully removed and examined. Results  A total of 25% of suicide victims reported a history of chronic stress, 13% self-destructive behavior, 3% untreated depression, and 8% reported financial or marital difficulties. The right adrenal gland was found to be heavier than the left in the control group. In addition, both left and right adrenal glands weighed more in males. Among the suicidal cases, the weight of the left adrenal gland was greater than that of the right, and the weight of the gland in males was higher than that in females. The difference in adrenal gland weight among males was significant in both case and control groups (combined p-value = 0.0001) but was insignificant in females, probably due to their disproportionate ratio in both groups. There was no significant relationship between adrenal gland weight and individual age or weight. However, adrenal gland weight in both groups was significantly associated with the height of the individual (p-value = 0.001 in the study group and < 0.05 in the control group). The difference in adrenal gland volume between the suicidal and control groups was not significant, indicating that the increase in size is not a differentiating criterion for acute and chronic stress. The relative adrenal gland weight was significantly higher in the suicidal group. Conclusion The external appearance of the adrenal gland may be regarded as a normal response to stress in relation to the mode of death. The left adrenal gland is more likely to show an increase in weight in response to chronic stress. The weight of the adrenal gland in both groups is significantly associated with the height of the deceased. Relative adrenal weight can be considered as specific for suicidal cases exposed to chronic stress. However, the volume of the adrenal gland may be considered an unreliable criterion in the differentiation of chronic stress from acute stress.