Adrenal disorders

The Adrenal Gland

Anatomy was first described in 1563.

Is located above (or attached to) the upper pole of the kidney.
Is pyramidal in structure and weights about four grams. Consists of the adrenal cortex and adrenal medulla Activities are regulation of fluid volume and stress response

The Adrenal Gland: Anatomy

Adrenal Histology

Adrenal Cortex
Is divided into 3 zones in the adult gland: Zona Glomerulosa, Zona Fasciculata, Zona Rericularis. Is divided onto 4 zones in the fetal gland. The three zones of the permanent cortex constitutes only 20% of the fetal glands size. The remaining zone (fetal cortex) comprises up to 80% of glands size during fetal life.

Adrenal Cortex: Steroid Hormone Production

Aldosterone, sex hormones, cortisol

Synthesized from cholesterolsteroid ring

Adrenal Cortex: Steroid Hormone Production

Figure 23-2: Synthesis pathways of steroid hormones

Cortisol Effects: Body Responses to Stress

Permissive effect on glucagon Memory, learning & mood Gluconeogenesis Skeletal muscle breakdown Lipolysis, calcium balance Immune depression Circadian rhythms

Cortisol Effects: Body Responses to Stress

Figure 23-4: Circadian rhythm of cortisol secretion

Control of Cortisol Secretion: Feedback Loops

External stimuli Hypothalamic Anterior Pituitary Adrenal cortex Tissues

Figure 23-3: The control pathway for cortisol

Cortisol: Role in Diseases and Medication

Use as immunosuppressant
Hyperimmune reactions (bee stings) Serious side effects

Hypercortisolism (Cushing's syndrome)

Tumors (pituitary or adrenal) Iatrogenic (physician caused)

Hypocortisolism (Addison's disease)

Aldosterone
Exclusively synthesized in Z. Glomerulosa Essential for life.

Promotes sodium retention and Potassium elimination by the kidney. Expands ECF volume

Regulation of Aldosterone Secretion

Aldosterone: Role in diseases

Complete failure to secrete aldosterone leads to death (dehydration, low blood volume). Hyperalsdosterone states: Contribute to hypertension associated with increased blood volume.

Adrenal Medulla: A Modified Sympathetic Ganglion

Sympathetic stimulation
Catecholamine release to blood
Epinephrine Norepinephrine

Travel to:
Multiple targets Distant targets

Adrenal Medulla: A Modified Sympathetic Ganglion

Figure 11-10: The adrenal medulla

Mechanism: Norepinephrine Release and Recycling

Figure 11-9: Norepinephrine release at a varicosity of a sympathetic neuron

Review of Efferent Pathways: Motor & Autonomic

Figure 11-11: Summary of efferent pathways

Catechalomines: Activity
Stimulates the fight or fight reaction Increased plasma glucose levels Increased cardiovascular function Increased metabolic function Decreased gastrointestinal and genitourinary function

Activity of Epinephrine

DISORDERS OF ALDOSTERONE

(A) Natural increase in cases of ,

( 1 ) Deficiency of sodium and plenty of potassium in the diet . ( 2 ) Heavy sweat .

(B) Natural decrease in cases of ,

( 1 ) Deficiency of potassium in the diet . ( 2 ) Having large amounts of water and drinks .

(C) Addison disease

Occurs when about 90% of cortex cells are damaged . So , it is very rare ( 8 / million person ) . Addisonian has a remarkable depression in aldosterone level which is accompanied by a low blood pressure , high temperature , weight loss , decreased blood sodium and increased blood potassium .

(D) Conn disease

Occurs due to increased activity of zona glomerulosa . Leads to increased secretion of aldosterone which results in a high blood pressure , low blood potassium and high blood sodium levels .

 Symptoms of Cushing syndrome include ;

( 1 ) Rapid weight gain specially from face , trunk and limbs . ( 2 ) very high blood sugar which may lead to diabetes mellitus . ( 3 ) High blood pressure (secondary) . ( 4 ) Osteoporosis due to increased protein breakdown . Cushing syndrome can be treated by surgery .

Disorders of cortisol
(1) Cushing syndrome A hormone disorder caused by high levels of cortisol in the blood . It may be caused by ; ( 1 ) Taking glucocorticoid drugs . ( 2 ) Tumors in cortisol secreting cells . ( 3 ) Tumors in ACTH secreting cells . Cushing syndrome is not confined to humans but relatively common in domestic animals .

( 2 ) Addison disease Deficiency in cortisol level in the blood . Leads to ; ( 1 ) Low blood sugar . ( 2 ) Low blood pressure . ( 3 ) High potassium levels in the blood . ( 4 ) Full body weakness .

pheochromocytoma
Very rare state . A tumor In the adrenal medulla that causes hypersecretion of catecholamines which leads to ; ( 1 ) Hypertension . ( 2 ) Very high blood sugar . ( 3 ) High rate of heartbeat .