Adrenal size is increased in multiple sclerosis.

OBJECTIVE

To determine if adrenal glands are enlarged in multiple sclerosis (MS). Patients with MS and major depression are insensitive to glucocorticoid feedback regulation. Depressed patients have excessively high glucocorticoid levels and enlarged adrenal glands. To our knowledge, this is the first study of adrenal size in MS. Chronic high levels of adrenal glucocorticoid in MS may downregulate responses to exogenous or endogenous steroids.

DESIGN

Retrospective postmortem analysis compared adrenal size in MS with that in other neurologic and non-neurologic diseases.

SETTING

Autopsy cases were obtained from the records of a tertiary care hospital.

PATIENTS

Ten patients had definite MS; 13, amyotrophic lateral sclerosis; and 14, acute myocardial infarction.

MAIN OUTCOME MEASURES

Adrenal and body weight at autopsy.

RESULTS

At postmortem examination, the adrenal glands of patients with MS were enlarged in comparison with the adrenal glands of patients who died of acute myocardial infarction or amyotrophic lateral sclerosis. The adrenal glands of the patients with MS were 36% larger than those of the patients with amyotrophic lateral sclerosis who had comparable body weights. The adrenal-body weight ratio was 40% greater in patients with MS than in patients who died of acute myocardial infarction.

CONCLUSIONS

The increased adrenal size in patients with MS may allow excessive glucocorticoid secretion in response to stress and affect immune regulation.