PHARMACOLOGY

OF THE ADRENAL CORTEX

dr.Siti Syarifah, M.Biomed

Dept. Pharmacology & Therapeutic

Faculty of Medicine, USU
Medan, 2016
 Endocrine Glands

hypothalamus pituitary
Thyroid gland

Adrenal Gland
pancreatic island
 Adrenocortical hormones
All the hormones that are secreted by
adrenal.
Adrenal cortex: glucocorticoids,
mineralocorticoids, sex hormones
Adrenal medulla: Epinephrine (AD), Nor
epinephrine (NAD)
Adrenocortical hormones

AD
NE
a Tissue section
of adrenal cortex
HPA (hypothalamic-pituitary-adrenal cortex)
axis

Hypothalamus

pituitary

adrenal cortex
 GLUCOCORTICOIDS

Antagonizing Muscle protein GH action on Anti-

insulin catabolism adypocytes inflammatory

Increase Inhibit
Raising blood Increase amino
acids hormone- cytokine
glucose sensitive lipase release

Maintain Regulate
energy Gluconeogenesis Lipolysis inflammatory
homeostasis response
 Primary
(Addisons
disease)
Adrenal
insufficiency Secondary
(Hypothalamus,pi
tuitary,
Patophysiology exogenous
glucocorticoids

Glucocorticoid Cushings
excess Syndrome
Cushings Promote Redistribution
syndrome lypolisis of body fat

Moon face Concentric

Trunk obese obesity
Central obesity Moon face Buffalo hump
CORTISOL AND GLUCOCORTICOID
ANALOGUES

Exogenous

Suppress
Replacement
inflammation and
therapy
immune response

Asthma Adrenal
Rheumatoid Rejection of insufficiency
arthritis transplantation
 Membrane phospholipids

GCS induce lipocortin-1 PLA2

Arachidonic acidAA

COX NSAIDs LOX

ProstaglandinsPGs LeukotrienesLTs
GlucocorticoidsGCS

21
18
20

12 17
11 13 16
19
14 15
1 9
2 10 8

5 7
3 6
4
Structure-activity relationship of
adrenocortical hormones

Steroid nucleus is a
basic structure
C3 = 0
C4-5
C20 =0
are necessary
C17:-OHC11:= O or OH are necessary for GCs.
C1-2: = Antiinflammatory effects stronger, effects of
water-electrolyte metabolism weaker
 C9:-FC16:-CH3 or -OH
Antiinflammatory effects stronger, effects of
water-electrolyte metabolism weaker.
PHARMACOLOGIC RELATIVE RELATIVE DURATION
AGENT GLUCOCORTICOID MINERALOCORTICOID OF ACTION
POTENCY ACTIVITY

Hydrocortisone 1 1 Short

Prednisolone 4-5 0.25 Short

Methylprednisolone 5-6 0.25 Short

Dexamethasone 18 <0.01 Long

Short acting < 12 hours

Long acting >48 hours
 ADVERSE EFFECTS
Increased susceptibility of infection
Raise plasma glucose level DM
Inhibit Vitamin D-mediated absorption of
calcium bone resorption
osteoporosis
Slow linear bone growth in children
short stature
Cushing syndromes
Osteoporosis
TAPPERING OFF!!!!
2.Withdrawal reactions

(Results from too rapid withdrawal of GCS after

prolonged therapy)
1) Iatrogenic adrenocortical insufficiency :
adrenocortical atrophy and adrenal crisis
Adrenal crisis: nausea,vomiting,weakness,
hypotension, hypoglycemia, shock.