Consilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum94429Research ArticleMacronodular bilateral adrenal hyperplasia: the pathogenesis and genetic aspectsYukinaM. Yuendo-yukina@yandex.ruNuralievaN. F-BeltsevichD. G-TroshinaE. A-PlatonovaN. M-Endocrinology Research Center of the Ministry of Health of the Russian Federation181889328122021Copyright © 2022, Consilium Medicum2022Macronodular bilateral adrenal hyperplasia (MBAH) in major cases is genetically-determined disease, which is manifested by symptoms of hypercortisolism. The MBAH is a diagnostic challenge due to the lack of usual clinical features, the questionable laboratory data, the great amount of tests, the different cutoff points and the lack of specificity of radiological characteristics.According to the latest data, a central role in hormonal hypersecretion and cellular proliferation in MBAH play aberrant membrane receptors of adrenal cortex, ectopic adrenocorticotropic hormone production, defects in adenylate cyclase and Wnt signaling systems, disorders of steroidogenesis. However, the exact molecular mechanisms, responsible for the development of MBAH, are unknown. The identification of pathogenetic mechanisms of development MBAH will allow to develop new methods of timely diagnostics and comprehensive treatment of the disease.macronodular bilateral adrenal hyperplasiaaberrant membrane receptorshypercortisolismмакронодулярная двусторонняя гиперплазия надпочечниковаберрантные мембранные рецепторыгиперкортицизм[Lacroix A, Feelders R.A, Stratakis C.A, Nieman L.K. Cushing’s syndrome. Lancet (England, London) 2015; 386 (9996): 913-27.][Lacroix A, Costa M.H.S. Cushing’s Syndrome Secondary to ACTH-Independent Macronodular Adrenal Hyperplasia. Arq Bras Endocrinol Metab 2007; 51 (8): 1226-37.][Cavagnini F, Giraldi F.P. Adrenal Causes of Cushing’s Syndrome. In: Jameson J.L, De Groot L.G, editors. Endocrinology: Adult and Pediatric. 7th Edition. 2015; р. 1775-809.][Hayakawa E, Yoshimoto T, Hiraishi K. et al. A rare case of ACTH-independent macronodular adrenal hyperplasia associated with aldosterone - producing adenoma. Intern Med 2011; 50 (3): 227-32.][Elbelt U, Trovato A, Kloth M. Molecular and clinical evidence for an ARMC5 tumor syndrome: concurrent inactivating germline and somatic mutations are associated with both primary macronodular adrenal hyperplasia and meningioma. J Clin Endocrinol Metab 2015; 100 (1): E119-28.][Christopoulos S, Bourdeau I, Lacroix A. Clinical and subclinical ACTH-independent macronodular adrenal hyperplasia and aberrant hormone receptors. Horm Res 2005; 64 (3): 119-31.][Fragoso M.C.B.V, Alencar G.A, Lerario A.M. Genetics of primary macronodular adrenal hyperplasia. J Endocrinol 2015; 224 (1): R31-43.][Ohashi А, Yamada Y, Sakaguchi K et al. A Natural History of Adrenocorticotropin-Independent Bilateral Adrenal Macronodular Hyperplasia (AIMAH) from Preclinical to Clinically Overt Cushing's Syndrome. Endocrine J 2001; 48: 677-83.][Lacroix A. ACTH-independent macronodular adrenal hyperplasia. Best Pract Res Clin Endocrinol Metab 2009; 23 (2): 245-59.][Anagnostis P, Karras S.N, Athyros V.G et al. Subclinical Cushing’s syndrome and cardiovascular disease. Lancet Diabetes Endocrinol 2014; 2 (5): 361.][Albiger N.M, Occhi G, Mariniello В et al. Food - dependent Cushing’s syndrome: from molecular characterization to therapeutical results. Eur J Endocrinol 2007; 157 (6): 771-8.][Lacroix A, Ndiaye N, Tremblay J, Hamet P. Ectopic and abnormal hormone receptors in adrenal Cushing’s syndrome. Endocr Rev 2001; 22: 75-110.][Lefebvre H, Duparc С, Provost G. Cell - to - cell communication in bilateral macronodular adrenal hyperplasia causing hypercortisolism. Front Endocrinol (Lausanne) 2015; 6: 34.][Bernichtein S, Alevizaki M, Huhtaniemi I. Is the adrenal cortex a target for gonadotropins? Trends Endocrinol Metab 2008; 19 (7): 231-8.][Louiset E, Lefebvre H. Intraadrenal corticotropin in bilateral macronodular adrenal hyperplasia. N Engl J Med 2014; 370 (11): 1071-2.][Newfield R.S. ACTH receptor blockade: a novel approach to treat congenital adrenal hyperplasia, or Cushing’s disease. Med Hypotheses 2010; 74 (4): 705-6.][Lefebvre H, Duparc С, Chartrel N. Intraadrenal adrenocorticotropin production in a case of bilateral macronodular adrenal hyperplasia causing Cushing’s syndrome. J Clin Endocrinol Metab 2003; 88 (7): 3035-42.][Lerario A.M, Moraitis A, Hammer G.D. Genetics and epigenetics of adrenocortical tumors. Mol Cell Endocrinol 2014; 386 (1-2): 67-84.][Stratakis C.А, Horvath А. How the new tools to analyze the human genome are opening new perspectives: the use of gene expression in investigations of the adrenal cortex. Ann Endocrinol (Paris) 2008; 69 (2): 123-9.]