HORMON

ADRENAL

Retty Ratnawati
Physiology Lab.
Fakultas Kedokteran, Universitas Brawijaya
Sept 2007
HORMON MEDULA ADRENAL
Hormon kel.adrenal di bagian MEDULA:
1. Katekolamin
2. Epinefrin
3. Norepinefrin
Fungsi:
mempersiapkan tubuh thdp. aktivitas fisik yang
merespon:
stres, Kegembiraan, cedera, latihan & penurunan
kadar gula darah.
Efek Epinefrin:
frekuensi jantung, metabolisme, Konsumsi O2
meningkat
Kadar gula darah meningkat
Pembuluh darah kulit & organ viseral Konstriksi, tapi di
otot rangka & jantung Dilatasi.
 Efek epinefrin (adrenalin) lanjutan:
Otot polos visera: relaksasi otot polos
lambung, usus, vesika urinaria, kontraksi
sfingter usus lambung & vesika urinaria.
Relaksasi otot polos bronkhus
Hepar: pemecahan glikogen
Otot: menambah pemecahan glikogen
Jar.lemak: lipolisis
Pankreas: menghalangi pelepasan insulin
 EFEK KATEKOLAMIN:
Reseptor beta:
menghambat sintesis AMP shg inhbisi
semua sel kecuali otot jantung.
Reseptor alfa:
Meningkatkan denyut jantung dan tekanan
darah
Meningkatkan gula darah (glikogenolisis)
Meningkatkan metabolisme oksidatif
glukosa dalam sel.
 2 DIVISION OF ANS:
1. SYMPATHETIC SYSTEM
2. PARASYMPHATHETIC SYSTEM

Sympathetic Parasympathetic
Pupil dilation tear Pupil constricts tear
production not production stimulated
affected
Heart rate increase Heart rate decrease
FIGHT OR NON
FLIGHT Bronchi dilate Bronchi constrict THREATHENING
RESPONSE Gastric+pancreatic Gastric+pancreatic
activity inhibited activity stimulated RELAX,
PREPARE GENERAL
FOR Glycogen converted Glucose converted
into glucose into glycogen HOUSE
HEAVY KEEPING
EXERCISE Release of Release of
adrenaline+ nor adrenaline + nor
adrenaline adrenaline cease
Peristalsis inhibited Peristalsis stimulated
Bladder relaxes Bladder constricts
 HORMON KORTEK ADRENAL
Hormon kel. Adrenal KORTIKAL:

a. Mineralokortikoid (z. Glomerulosa)

- Aldosteron (penting pada RAAS)

b. Gonadokortikoid (z. Retikularis)

- Steroid ini (androgen) berfungsi sebagai
prekursor pengubahan testosteron dan estrogen
oleh jaringan lain

c. Glukokortikoid (z. Fasikulata)

Kortikosteron
Kortisol * Berbeda struktur
Kortison
* Obat dewa
 EFEK GLUKOKORTIKOID
Mempengaruhi metabolisme karbohidrat,
protein dan lemak, membentuk cadangan
molekul yang siap dimetabolisme
Meningkatkan glukosa (glukoneogenesis)
darah
Glikogenesis di hati
Meningkatkan penguraian lemak dan protein
Stabilisasi membran lisosom untuk
mencegah kerusakan jaringan lebih lanjut
Meningkatkan sekresi asam lambung
 KENDALI SEKRESI
GLUKOKORTIKOID
Melalui kerja ACTH dalam mekanisme
umpan balik negatif
Stimulus ACTH adalah semua jenis
stres fisik dan psikis
 ABNORMALITAS SEKRESI
ADRENOKORTIKAL

HIPOSEKRESI
Destruksi jaringan kortikal atau penyakit atau
atrofi
Addison disease
Ketidakseimbangan Na-K darah
Penghitaman kulit
Penurunan kemampuan untuk merespons stres
fisiologis
 ABNORMALITAS SEKRESI
ADRENOKORTIKAL
HIPERSEKRESI:
Akibat tumor adrenal atau peningkatan ACTH

1. ALDOSTERONISME PRIMER (aldosteron >)

2. CUSHINGS SYNDROME (glukokortikoid >)
3. SINDROMA ADRENOGENITAL (virilisme adrenal): androgen>
a. Pubertas dini
b. Maskulinisasi (pada perempuan dewasa, pad janin bila ibu
yang menderita)
4. Glukokortikoid dalam jumlah besar sebagai terapi (mengurangi
respon inflamasi dan alergi)
EFEK POSITIF: stabilisasi membran lisosom dan penurunan
kapiler shg menghambat inflamasi
EFEK NEGATIF: menghambat respon sel darah putih thdp
infeksi dan menurunkan produksi antibodi shg
memperlama penyembuhan luka
CLINICAL FEATURES OF CUSHING SYNDROME:

1.Sudden weight gain

2.Central obesity
3.Hypertension
4.Facial plethora
5.Proximal muscle weakness
6.Glucose intolerance or diabetes mellitus
7.Decreased libido or impotence
8.Depression or psychosis
9.Osteopenia or osteoporosis
10.Easy bruising
11.Hyperlipidemia
12.Menstrual disorders
13.Violaceous striae wider than 1 cm
14.Recurrent opportunistic or bacterial infections
15.Acne
16.Hirsutism
 DEFINITION
CUSHING SYNDROME:
HYPERSECRETION OF ADRENAL
CORTEX, HYPERCORTISOLSM.

CUSHING DISEASE:
SECONDARY TO EXCESS
SECRETION OF ACTH BY THE
ANTERIOR PITUITARY.
AMANDAS STORY
Currently I'm 22 (23 yrs old next month) and I live in Missouri.
My last year in high school I noticed I was gaining some weight and got the
"buffalo hump" I went to a doc. about the hump. He took x-rays and said I was fine. I was
active in sports so I couldn't explain the sudden increase in weight. My face was getting
slightly rounded not alot at this time and I was having night sweats. My regular doc. said
he thought I looked like I might have Cushing's but had never dealt with that before. He did
a 24 hour urine which was slightly elevated. He suggested I see an endo. I started having
migraine headaches also.
The first endo. looked at me and said no it wasn't Cushing's but tested me for
Diabetes. That was negative and he was not going to do any further testing. Chalk the
weight up to being stressed.
After high school I started nursing school. I learned I had high blood pressure all the time.
So my regular doc. put me on meds, ran a thyroid panel (negative), suggested neurologist
for the headaches. The neuro. changed the BP meds and put me on an antidepressant.
Took those for a while but had to stop 'cause they made it terribly difficult to force myself
out of bed. I felt awful and so tired. I went to another endo. He ran more urine tests which
were barely elevated and said go home I was stressed out and he would run the tests
again in several months but this wasn't Cushing's.
I stopped having periods somewhere along the line and steadily gaining weight. I
have stretch marks on my hips, stomach, underarms, and buttocks.
I am totally heat intolerant.
AMANDA (contd)
I went to the Mayo Clinic in Rodchester (11 hour drive for me) but got no
results there either. They told me to avoid stress, go on diet, and stop smoking.
So I started to get extremely depressed as you all can relate to. So I tried going to
an OB GYN who had no clue what to do other than give me birth control to help
me start my period. The 2nd OB GYN I went to took one look at me and said I had
Polycystic Ovarian Syndrome. She never ran a single test but told me take BC
pills an increase my calcium intake.
I had to stop taking the BC pills 'cause they made my headaches worse. I
went back to my previous OB GYN and she did a pelvic ultrasound. She said I did
have polycystic ovarys. She gave me a med called Provera to make me have a
period. Now I hadn't had one in 3 years or more. The med. didn't work so she said
to try it again. Still no luck. She said she was at a loss. So off I go to another OB
GYN. He gave me BC pills and put me on Rezulin (diabetic drug) to treat my so
called PCOS. I did start having periods but terrible headaches.
Next stop was a neuro. He put me on Blood pressure meds and Depakote for the
headaches. I'm still on those now and they help a lot. I'm down to one headache a
week instead of 3-4.
Went to another OB GYN who had an endo background. After a bunch of
blood work and a 24 hour urine which was extremely high, she suggested that I
do the dexamthasone test. I tried to get that done 2 different times but the lab kept
screwing up the results or something. She wanted me to repeat it but i was
already upset about the whole situation. Plus she was a 2 hour drive.
AMANDA (contd)

I find myself having a very hard time concentrating on anything for a

very long period of time. My mood swings are terrible! I think my family
lives in fear. lol. My short term memory seems to be getting worse also. I'm
always so tired and my muscles ache after the slightest activity. My hair is
thinning and of course my skin is always the prettiest of colors!
I forgot to mention I had an MRI of my head during the first year I
noticed my symptoms but it showed nothing. I had a CAT SCAN done while
in at the hospital with a migraine. It also didn't show anything.
So now Mad at the world and still depressed, I started looking on
the internet. I came in contact with a woman from the PTNA and she gave
me a doctors name and I called and made an appointment with him. He
finally diagnosed me with Cushing's. I had another MRI done and he
spottted my tumor. He is suppose to call me back on Monday the 22 and let
me know when he is going to do the surgery.
I wouldn't have made it this far without both of my parents and a
couple of close friends. They have always been there for me when I needed
them.
WILLIAMS STORY

My name is Jennifer. This story isn't about me. It's about my son. His
name is William. He is only 2 and a half years old.
In the summer of 2000 William got a little over weight and I thought it was
nothing. In the fall,winter he lost the weight and I thought everything was okay
until he gained the weight back this summer. Only it was worse this time.
He also gained what I thought was a bad rash. Well we took him to the
emergency room. They took some urine samples,some blood work and then
told me we are going to do a catscan.
After the catscan none of the doctors told me what was going on until
finally I said could some tell me what in the hell is going on? That's when one
doctor
took the time to tell me well what we think your son has is a disease called
cushings. So that explained his sudden weight gain,the massive amounts of
hair
and the rash which turned out to be acne.
They asked if they could take pictures of my son to put in books and
magazines to help other mothers figure out what there child may have so they
can get it treated right away.
WILLIAMS STORY (CONTINUED)

The hospital we were at didn't specialize in the treating of cushings

so they sent us to Childrens hospital. We were admitted overnight. They
told me not to feed him for 24 hours. So at 8pm that night he got nothing
else to eat or drink. Well come 11am the next morning William was getting
mad. He was hungry.I went and asked the doctors when the hell is my child
going to get to eat and have a drink? They said mam we don't know why
they told you not to feed him or give him a drink.I was mad.It was bad
enough having him in that hospital but even worse he was thirsty and
starved for no reason.
That morning they ordered more catscans. William was not a happy
2 year old. The doctors didn't give me much comfort. After the catscans it
was confimed. He had cushings. He also had tumors by his left kidney and
some on his lymph nodes. They said they had to operate.
The doctors said there is a chance your son will not make it through
surgery. I was told they were going to try to get all of the tumors out but
probably wouldn't be able to. The doctors managed to get out the big chunk
of the tumor to examine in pathology.
A couple days after surgery they let my son go home from the
hospital. On my sons release date he fell out of his bed and hit his head on
the cement floor. All because I stepped out of the doctors way so he could
take out my sons central line. The doctor stood right by my son and
watched him fall out.
WILLIAMS STORY (CONTINUED)

In the time my son was admitted,my son took out his catheter that
collected his urine, his nose to tube from the surgery and when he fell out of the
bed he ripped out his central line. My son has been through hell because of this
disease.
I had a doctors appointment with Williams doctors to see what pathology had to
say about the tumors. I wasn't prepared for what the doctor said. This disease
only effects people in ages 20 to 50 years old and even then this disease is very
rare. William's doctors had only seen 3 cases like Will's and those patients did
not make it. The doctor also said the tests came back and it shows your sons
tumors are cancer.
He said we are going to do everything we can for your son but I am
warning you now he may not make it. So for now William and I keep going to the
appointments and struggling to understand why this happened to him.
I hope this story helps to make other moms realize this could happen to your
child,.I just hope it doesn't.
This is hurting my son. If these doctors tell me there is nothing else we
can do for your son I won't let them hurt him anymore by letting them poke and
prick him for more blood and more catscans just let my little boy die in peace. .
Let him be happy and carefree once again.
FIGURE 4. T1-weighted sagittal
magnetic resonance image of a
pituitary macroadenoma (black arrow)
with tumor erosion into sphenoid air
cells (white arrow).
FIGURE 5. T1-weighted coronal
magnetic resonance image of a
pituitary macroadenoma (black arrow)
with compression of the supracellar
structures and optic chiasm (white
arrow).
PATIENT
CUSHING
SYNDROME

SAME
PATIENT
2 YEARS
AFTER
TREATMENT