Miscellaneous Changes

Abstract

Mention has already been made of the tendency of fetal adrenal cytomegaly to be apparently associated with Rh-incompatibility of the newborn (p. 286) with perhaps 10% of such cases showing this feature (Burne and Langley 1956). Other changes found with this condition include intra-adrenal haemopoeitic foci in about half the cases with their frequency increasing with the severity of the anaemia (Burne and Langley 1956). Newborn and stillborn adrenal weights are slightly (~ 20%) increased in this disease, possibly as a consequence of oedema, although the cortical cells themselves are somewhat hypertrophied with an increased cytoplasmic volume (Naeye 1967). The most striking adrenal change in erythroblastosis fetalis is, however, a marked cytoplasmic vacuolation in the fetal zone. This is reportedly seen in >80% of such glands and involves the entire fetal zone in nearly half the cases studied (Bartman and Driscoll 1969). Similar vacuolation, which appears to be due in part at least to lipid accumulation, is also seen in α-thalassaemia (Pearson et al. 1965) a non-immunological haemolytic anaemia. Care should be taken not to confuse this condition with congenital lipoid hyperplasia due to enzymatic defects (p. 167) where the secretion of steroid hormones by the gland is virtually abolished.