Adrenocortical involvement in aluminium phosphide poisoning

Area of Science:

• Toxicology
• Endocrinology
• Pathology

Background:

• Aluminium phosphide (AlP) is a potent systemic poison.
• AlP poisoning can affect various organs, including the adrenal cortex.
• Understanding the adrenal response is crucial for managing AlP toxicity.

Purpose of the Study:

• To investigate the effect of AlP poisoning on the adrenal cortex.
• To correlate adrenal function and histopathology with patient outcomes.
• To explore potential mechanisms of adrenal dysfunction in AlP poisoning.

Main Methods:

• Study included 30 patients diagnosed with AlP poisoning.
• Plasma cortisol levels were measured.
• Autopsy and histopathological examination of adrenal glands and other viscera were performed.

Main Results:

• Twenty patients showed a significant rise in plasma cortisol (>1048 nmol/l) with 50% mortality.
• Ten patients had critically involved adrenal cortex, failed cortisol rise (<690 nmol/l), severe histopathological changes, and 100% mortality.
• Histopathology of other organs revealed congestion, edema, cellular infiltration, necrosis, fatty changes, and hepatization; cardiovascular shock was suspected.

Conclusions:

• Severe adrenal cortex involvement and low cortisol levels are associated with high mortality in AlP poisoning.
• Adrenal dysfunction may result from shock or direct toxic effects of phosphine.
• Histopathological findings suggest cardiovascular shock may contribute to mortality.