short lecture for adrenal gland

1. ADRENAL GLANDS
By Sara Sami
Yuzuncu Yil University
2015

2. ADRENAL GLANDS
• Adrenal Cortex
• Adrenal Medulla

3. ADRENAL CORTEX
• Salt
• Sugar
• Sex

4. SALT
• Mineralocorticoids (F & E balance)
– Aldosterone (renin from kidneys controls adrenal
cortex production of aldosterone)
• Na retention
• Water retention
• K excretion

5. SUGAR
• GLUCOCORTICOIDS
(regulate metabolism & are critical in stress
response)
– CORTISOL responsible for control and &
metabolism of:
a. CHO (carbohydrates)
– glucose formed
– glucose released

6. CORTISOL
FATS-control of fat metabolism
• stimulates fatty acid mobilization from
adipose tissue
PROTEINS-control of protein metabolism
– stimulates protein synthesis in liver
– protein breakdown in tissues

7. • Other fxs of Cortisol
– inflammatory and allergic
response
– immune system therefore prone to
infection

8. SEX
• ANDROGENS
– hormones which male characteristics
• release of testosterone
• Clear more in women than men

9. • Adrenal cortex
Glucocorticoids mineralocorticoids sex
Hydro cortisone corticosterone

10. The Adrenal Gland
The adrenal glands (also known as suprarenal
glands) are endocrine glands that sit atop the
kidneys; in humans, the right suprarenal gland is
triangular shaped, while the left suprarenal gland is
semilunar shaped.
It is pyramidal in structure and weights about four
grams.

11. RELEASE OF
GLUCOCORTICOIDS IS
CONTROLLED BY ______

12. LET’S LOOK AT ACTH
(adrenocorticotropic Hormone)
• Produced in anterior pituitary gland

13. ACTH
cortisol
– levels cause stimulation of ACTH
– levels cause dec. release of ACTH

14. Each adrenal gland has two distinct
structures, the adrenal cortex and the
medulla, both of which produce
hormones.
The cortex mainly produces cortisol,
aldosterone and androgens, while the
medulla chiefly produces epinephrine
and norepinephrine.
Parts Of Adrenal Gland

15. • The adrenal cortex is devoted to the synthesis of
corticosteroid hormones.
• Specific cortical cells produce particular hormones
including cortisol, corticosterone, androgens such as
testosterone, and aldosterone.
• The cortex is regulated by neuroendocrine hormones
secreted by the pituitary gland and hypothalamus, as
well as by the renin-angiotensin system.
Adrenal Cortex: Steroid
Hormone Production

16. The Adrenal Gland
In General
These hormones control many important functions in the
body, such as:
1. Maintaining metabolic processes, such as managing
blood sugar levels and regulating inflammation
2. Regulating the balance of salt and water
3. Controlling the "fight or flight" response to stress
4. Maintaining pregnancy
5. Initiating and controlling sexual maturation during
childhood and puberty

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

18. – The outermost layer, the zona glomerulosa is the
main site for production of mineralocorticoids,
mainly aldosterone,
– Aldosterone is largely responsible for the long-term
regulation of blood pressure.
• Complete failure to secrete aldosterone leads to death
(dehydration, low blood volume).
• Hyperalsdosterone states: Contribute to hypertension
associated with increased blood volume.
Glomerulosa,

19. SIGNS & SYMPTOMS
Hyperaldosteronism
• Na and water retention
–H/A, HTN
• K+ (hypokalemia)
• What is the normal serum K+ level???
• Usually no edema

20. DIAGNOSIS-Hyperaldosteronism
• urinary K
• plasma
aldosterone levels
with low plasma
renin levels
• CT scan
• EKG changes

21. INTERVENTIONS
Hyperaldosteronism
• BP -aldactone=Aldosterone antagonist
so what will it do to Na, H2O, and K???
• Correct hypokalemia/hypernatremia
– K+ supplements; low Na diet
• Partial or total adrenalectomy

22. – Situated between the glomerulosa and
reticularis, the zona fasciculata is responsible
for producing glucocorticoids, chiefly cortisol in
humans.
– The zona fasciculata secretes a basal level of
cortisol but can also produce bursts of the
hormone in response to adrenocorticotropic
hormone (ACTH) from the anterior pituitary.
Fasciculata

23. • The inner most cortical layer, the zona reticularis
produces androgens, mainly
dehydroepiandrosterone (DHEA) and DHEA
sulfate (DHEA-S) in humans.
Reticularis

24. 1. Permissive effect on glucagon
2. Memory, learning & mood
3. Gluconeogenesis
4. Skeletal muscle breakdown
5. Lipolysis, calcium balance
6. Immune depression
7. Circadian rhythms
Cortisol Effects: Body Responses
To Stress

25. • 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)
Cortisol: Role in Diseases and
Medication

26. Adrenal Gland Disorders
 Adrenal gland disorders occur when the
adrenal glands don’t work properly.
 Sometimes, the cause is a problem in another
gland that helps to regulate the adrenal
gland.
 In other cases, the adrenal gland itself may
have the problem.

27. ADRENAL INSUFFICIENCY

28. Adrenal Gland Disorders
 Some examples include:
1. Cushing's Syndrome
2. Congenital Adrenal Hyperplasia
3. Pituitary Tumors

29. CUSHING’S SYNDROME
• Hypersecretion of cortisol caused by
endogenous production/excessive use of
corticosteroids

30. CLINICAL SYMPTOMS
• Weight gain / central obesity
• Diabetes
• Hirsutism
• Hypertension
• Skin changes ( abd striae, facial plethora,
ecchymosis, acne)
• Muscle weakness
• Depression / mania
• Osteoporosis
• Hypokalemia

32. DIAGNOSIS
• Morning and midnight plasma cortisol levels
are elevated
• Dexamethasone fails to suppress 24-hour
urinary cortisol excretion.
• Serum ACTH level

33. Treatment
Cushing’s syndrome
 The treatment for Cushing’s syndrome depends
on the cause. If the excess cortisol is caused by
medication, your health care provider can
change dosages or try a different medication to
correct the problem.
 If the Cushing’s syndrome is caused by the
body making too much cortisol, treatments
may include oral medication, surgery,
radiation, or a combination of these
treatments.

34. Cortisol replacement
• You need steroid medication to replace the
cortisol which you no longer make. This is
usually with a medicine called hydrocortisone
which is very similar to cortisol. The amount is
usually about 15-25 mg each day. Some
people need more than this, and others less.
The daily amount is broken up into two or
three doses each day with a higher dose taken
in the morning than in the evening. For
example, you may be advised to take 15 mg in
the morning and 10 mg early evening.

35. ETIOLOGY HYPERPLASIA
• Adrenal hyperplasia - which means there is
increased number and growth of the cells in
the adrenal glands. These cells then make too
much cortisol. There are various different
types of adrenal hyperplasia.
• A benign (noncancerous) tumour of an
adrenal gland.
• A malignant (cancerous) tumour of an adrenal
gland

36. Treatment
Congenital adrenal hyperplasia
 Congenital adrenal hyperplasia can’t be cured,
but it can be treated and controlled. People
with congenital adrenal hyperplasia can take
medication to help replace the hormones their
bodies are not making.
 Some people with congenital adrenal
hyperplasia only need these medications when
they are sick, but others may need to take
them every day.

37. Treatment
 Doctors can successfully treat most pituitary
tumors with microsurgery, radiation therapy,
surgery, drugs, or a combination of these
treatments.
 Surgery is currently the treatment of choice for
tumors that grow rapidly, especially if they
threaten or affect vision.The treatment plan for
other pituitary tumors differs according to the
type and size of the tumor.

38. • Replacing aldosterone
Fludrocortisone is a substitute medicine for
aldosterone. This helps to regulate blood
pressure and blood salt level. You may also be
advised to take extra salt each day.
• Addisonian crisis
• This is a medical emergency. You will be given
hydrocortisone injections, a 'drip' of fluid to
bring up your blood pressure, and may need
intensive care until the crisis is over. then
need to continue taking hydrocortisone
medication

39. TREATMENT
Addisonian Crisis
• Rapid infusion of IV fluids
• Check VS and urine output frequently
• Monitor EKG
• Give solu-cortef IV Q6 hours until S & S
disappear

40. TREATMENT
• Try to decrease anxiety
• May have to give vasopressors
– Dopamine or Epinepherine
• Avoid additional stress

41. ETIOLOGY AND RISK FACTORS
• Tuberculosis (TB) :TB is an infection which
usually affects the lungs. In some cases the
infection can spread to, and gradually
destroy, the adrenals
• Other infections can sometimes affect both
adrenals.
• Cancers of other parts of the body can spread
and destroy the adrenals.
• Rare hereditary conditions.
• adrenalectomy
• Auto immune diseases: auto-immune
diseases the immune system makes
antibodies against part or parts of the body.
In auto-immune Addison's disease, you make
antibodies which attach to cells in the adrenal
cortex

42. CLINICAL MANIFESTATION
• General weakness and becoming easily
tired.
• Darkened areas of skin ('pigmentation').
• Blood pressure is low and falls further
when you stand which can make you
dizzy.
• Being off your food and weight loss.
• Feeling sick and vomiting from time to
time.
• Abdominal pains which may come and go.
• Diarrhoea or constipation which may
come and go.
• Cramps and pains in muscles.
• Craving for salt, or salty foods and drinks.
• Menstrual periods in women may become
irregular, or stop.

43. • Drugs that stimulate the sympathetic nervous
system (SNS)
So its Also known as
• adrenergic agonists or sympathomimetics
norepinephrine (NE) and epinephrine (EPI)

44. Thank you for
your attention