title: Adrenal medullitis in type I diabetes.
abstract: To investigate whether cell-mediated immunity against the adrenal medulla occurs in type I diabetes (IDDM), we conducted a retrospective autopsy study of adrenal glands from IDDM and nondiabetic subjects using formalin-fixed tissue. Forty-four IDDM subjects, aged 4-67 yrs (mean +/- SD, 44.8 +/- 15.4) with a duration of IDDM from 0-55 yr (28.6 +/- 14.2), and 29 nondiabetic controls, aged 8-82 yr (51.8 +/- 18.6), were evaluated for a lymphocytic infiltrate using UCHL1, which recognizes a subpopulation of resting T-lymphocytes and most activated T-lymphocytes. Immunohistochemistry using antihuman B-cell antibody (L26) was also performed. Sections were scored for both lymphocytic infiltrates and fibrosis [none (0), small (1), moderate (2), or large (3)]. Blinded scoring was performed. A moderate to severe UCHL1 infiltrate was present in 9 of 44 (20%) IDDM, compared with 1 of 29 (3%) control subjects (P less than 0.04). Mild to severe fibrosis (score 1, 2, or 3) was present in 22 of 42 (52%) IDDM subjects compared with 4 of 25 (16%) control subjects (P = 0.003). Eight of 42 (19%) IDDM subjects had moderate to severe fibrosis (score 2 or 3) compared with 1 of 25 (4%) control subjects. Seventeen of 44 (39%) IDDM subjects had either a moderate to large cellular infiltrate or moderate to severe adrenal medullary fibrosis compared with 2 of 29 (7%) control subjects (P = 0.003). Staining of the adrenal medulla with L26 revealed a large cellular infiltrate in only one subject who was UCHL1 negative. Adrenal medullitis was observed in 20% of IDDM subjects, suggesting that the adrenal medulla may be another immunological target in IDDM.
authors.affiliation: Joslin Diabetes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215.
authors.forename: F M
authors.initials: FM
authors.lastname: Brown
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Longway
authors.forename: S L
authors.initials: SL
authors.lastname: Rabinowe
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000473:pathology; D000313:Adrenal Medulla / Q000276:immunology / Q000473:pathology*; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000473:pathology; D001402:B-Lymphocytes / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology / Q000473:pathology*; D005355:Fibrosis; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008875:Middle Aged; D013601:T-Lymphocytes / Q000473:pathology