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Dr. Eman El Eter
 Main glucocorticoids in humans:
 Cortisol
 Corticosterone
 Cortisol:corticosterone produced in humans
in a ratio of 10:1
 90-95% bound to plasma protein.
 Under control primarily by ACTH
Glucocorticoids:
 After ACTH has been produced, cortisol will be
evident 15 to 30 minutes later
 There are usually 7-15 episodes per day
 There is a major burst in the early morning before
awakening.
Natural episodic Secretion Rhythm
 increased release with coffee consumption
 increases with increased exercise time &
intensity
 ↑ cortisol ↓testosterone
Cortisol secretion can be affected by:
 Steroid hormones when released from adrenal cortex into
blood stream they bind to protein carriers:
 Cortisol binding globulin (CBG) (transcortin)
 Albumin
 Only unbound steroid hormones are biologically active
 (~2%)
 To cross the target tissue membrane, the hormone must
dissociate from its carrier protein
Steroid hormone transport:
Figure 21.15
Regulation
of Cortisol
release
Regulation of Cortisol Release cont
Enhanced release can be caused by:
• physical trauma
• infection
• extreme heat and cold
• exercise to the point of exhaustion
• extreme mental anxiety
• Coffee consumption.
•Intense ex.
 Free cortisol is excreted into urine.
 Metabolized in liver by reductases &
conjugated to glucuronides and excreted via
kidney
Cortisol metabolism:
Increases blood glucose levels by:
 (+) glucogenesis in the liver via stimulating
the enzymes involved in glucogenesis.
 Decreasing utilization of glucose by cells
via direct inhibition of glucose transport
into cells.
Physiological effects of Cortisol”
Carbohydrate Metabolism:
 Reduces protein formation except liver
 Extrahepatic protein stores reduced (catabolic)
 amino acids not transported into muscle cells
↓ protein synthesis & ↑ amino acid blood levels
 These high blood amino acid levels are
transported more rapidly to hepatic cells for
glucogenesis and protein synthesis in liver
Protein metabolism
 Lipolytic.
 Mobilizes fatty acids & glycerol from adipose
tissue lead to↑ their blood concentrations
makes more glycerol available for
glucogenesis.
 Fat broken down & less formed due to less
glucose transported into fat cells.
 Redistribution of body fat:
↑ formation of fat in trunk areas & face
↓ fat (& muscle) from extremities
 Increases appetite
Fat metabolism:
Anti-inflammatory effects:
Stabilizes lysosomal membrane
Reduces degree of vasodilatation
Decreases permeability of capillaries
Decreases migration of white blood cells
Suppresses immune system
 Decrease production of eoisinophils and
lymphocytes
 Suppresses lymphoid tissue systemically therefore
decrease in T cell and antibody production thereby
decreasing immunity
 Decrease immunity could be fatal in diseases such
as tuberculosis
 Decrease immunity effect of cortisol is useful during
transplant operations in reducing organ rejection.
Effects on blood cells and immunity
 Maintains body fluid volumes & vascular integrity
 Cortisol levels vary with water intake
 Cortisol has mineralcorticoid effect, Not as potent
as aldosterone.
 BP regulation & cardiovascular function:
Sensitizes arterioles to action of noradrenaline
(Permissive effect).
 Decreased capillary permeability
 Maintins normal renal function
Effects on the circulation:
 Negative feedback control on release of ACTH
 Modulates perception & emotion
Mineral metabolism:
Anti-vitamin D effect
GIT:
Increases HCl secretion
CNS responses:
 Permissive regulation of fetal organ
maturation
 Surfactant synthesis (phospholipid that
maintains alveolar surface tension).
 Inhibition of linear growth in children due to
direct effects on bone & connective tissue
Developmental functions:
 Exogenous
 Most cortisol excess is induced by steroid
therapy
 (prednisone) to manage disease
 􀂄 asthma
 􀂄 rheumatoid arthritis
 􀂄 lupus
 􀂄 other inflammatory diseases
 􀂄 immunosuppression after transplantation
Cushing syndrome
Disorders of Cortisol Secretion
Causes:
Endogenous
 􀂄 Due to excessive production of cortisol:
 􀂄 ACTH- independent:
Primary adrenal defect (adenoma)
 􀂄 ACTH-dependent:
Overproduction of ACTH by pituitary
Overproduction of ACTH by ectopic ACTH-
producing tumor
Both exogenous & endogenous hyperfunction show
manifestations of Cushing’s disease
Cortisol excess, continued,…………………
 Carbohydrate metabolism
↑ blood glucose levels
↓ sensitivity to insulin, “Adrenal diabetes”
 Protein metabolism
↑ protein loss
muscle atrophy
thin skin
(-) collagen deposition in the skin (striea)
bone matrix & mass losses; bone formation
↓lessCa2+ absorbed & more excreted in urine
osteoporosis
 Fat metabolism
redistribution of body fat:
↑trunk & face fat deposition & ↓
extremities fat deposition.
 Buffalo torso
◦ Redistribution of fat from lower parts of the body to the
thoracic and upper abdominal areas
 Moon Face
◦ Edematous appearance of face
◦ Acne & hirsutism( excess growth of facial hair)
Hypertension due to Na retention & K
excretion.
Hypervolemia
Hypernatremia due to increased Na absorption.
Hypokalemia due to increased K excretion.
Decreases inflammatory response
 Increased infection susceptibility
 Ab synthesis suppressed & normal immune
responses to infecting pathogens suppressed
 Decrease in fibrous tissue formation &
impaired wound healing.
 Cushing syndrome –
Cushing’s Syndrome
striae
“moon face”
 Proximal muscle
wasting & weakness
 Osteoporosis
 Glucose intolerance
 HTN, hypokalemia
 Thromboembolism
 Depression, Psyc
 Infection
 Glaucoma
 Removal of adrenal tumor if this is the cause
 Microsurgical removal of hypertrophied
pituitary elements to reduce ACTH secretion

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10Adrenal_gland.ppt

  • 1. Dr. Eman El Eter
  • 2.  Main glucocorticoids in humans:  Cortisol  Corticosterone  Cortisol:corticosterone produced in humans in a ratio of 10:1  90-95% bound to plasma protein.  Under control primarily by ACTH Glucocorticoids:
  • 3.  After ACTH has been produced, cortisol will be evident 15 to 30 minutes later  There are usually 7-15 episodes per day  There is a major burst in the early morning before awakening. Natural episodic Secretion Rhythm
  • 4.  increased release with coffee consumption  increases with increased exercise time & intensity  ↑ cortisol ↓testosterone Cortisol secretion can be affected by:
  • 5.  Steroid hormones when released from adrenal cortex into blood stream they bind to protein carriers:  Cortisol binding globulin (CBG) (transcortin)  Albumin  Only unbound steroid hormones are biologically active  (~2%)  To cross the target tissue membrane, the hormone must dissociate from its carrier protein Steroid hormone transport:
  • 7. Regulation of Cortisol Release cont Enhanced release can be caused by: • physical trauma • infection • extreme heat and cold • exercise to the point of exhaustion • extreme mental anxiety • Coffee consumption. •Intense ex.
  • 8.  Free cortisol is excreted into urine.  Metabolized in liver by reductases & conjugated to glucuronides and excreted via kidney Cortisol metabolism:
  • 9. Increases blood glucose levels by:  (+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis.  Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells. Physiological effects of Cortisol” Carbohydrate Metabolism:
  • 10.  Reduces protein formation except liver  Extrahepatic protein stores reduced (catabolic)  amino acids not transported into muscle cells ↓ protein synthesis & ↑ amino acid blood levels  These high blood amino acid levels are transported more rapidly to hepatic cells for glucogenesis and protein synthesis in liver Protein metabolism
  • 11.  Lipolytic.  Mobilizes fatty acids & glycerol from adipose tissue lead to↑ their blood concentrations makes more glycerol available for glucogenesis.  Fat broken down & less formed due to less glucose transported into fat cells.  Redistribution of body fat: ↑ formation of fat in trunk areas & face ↓ fat (& muscle) from extremities  Increases appetite Fat metabolism:
  • 12. Anti-inflammatory effects: Stabilizes lysosomal membrane Reduces degree of vasodilatation Decreases permeability of capillaries Decreases migration of white blood cells Suppresses immune system
  • 13.  Decrease production of eoisinophils and lymphocytes  Suppresses lymphoid tissue systemically therefore decrease in T cell and antibody production thereby decreasing immunity  Decrease immunity could be fatal in diseases such as tuberculosis  Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection. Effects on blood cells and immunity
  • 14.  Maintains body fluid volumes & vascular integrity  Cortisol levels vary with water intake  Cortisol has mineralcorticoid effect, Not as potent as aldosterone.  BP regulation & cardiovascular function: Sensitizes arterioles to action of noradrenaline (Permissive effect).  Decreased capillary permeability  Maintins normal renal function Effects on the circulation:
  • 15.  Negative feedback control on release of ACTH  Modulates perception & emotion Mineral metabolism: Anti-vitamin D effect GIT: Increases HCl secretion CNS responses:
  • 16.  Permissive regulation of fetal organ maturation  Surfactant synthesis (phospholipid that maintains alveolar surface tension).  Inhibition of linear growth in children due to direct effects on bone & connective tissue Developmental functions:
  • 17.  Exogenous  Most cortisol excess is induced by steroid therapy  (prednisone) to manage disease  􀂄 asthma  􀂄 rheumatoid arthritis  􀂄 lupus  􀂄 other inflammatory diseases  􀂄 immunosuppression after transplantation Cushing syndrome Disorders of Cortisol Secretion Causes:
  • 18. Endogenous  􀂄 Due to excessive production of cortisol:  􀂄 ACTH- independent: Primary adrenal defect (adenoma)  􀂄 ACTH-dependent: Overproduction of ACTH by pituitary Overproduction of ACTH by ectopic ACTH- producing tumor Both exogenous & endogenous hyperfunction show manifestations of Cushing’s disease Cortisol excess, continued,…………………
  • 19.  Carbohydrate metabolism ↑ blood glucose levels ↓ sensitivity to insulin, “Adrenal diabetes”  Protein metabolism ↑ protein loss muscle atrophy thin skin (-) collagen deposition in the skin (striea) bone matrix & mass losses; bone formation ↓lessCa2+ absorbed & more excreted in urine osteoporosis
  • 20.  Fat metabolism redistribution of body fat: ↑trunk & face fat deposition & ↓ extremities fat deposition.  Buffalo torso ◦ Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas  Moon Face ◦ Edematous appearance of face ◦ Acne & hirsutism( excess growth of facial hair)
  • 21. Hypertension due to Na retention & K excretion. Hypervolemia Hypernatremia due to increased Na absorption. Hypokalemia due to increased K excretion.
  • 22. Decreases inflammatory response  Increased infection susceptibility  Ab synthesis suppressed & normal immune responses to infecting pathogens suppressed  Decrease in fibrous tissue formation & impaired wound healing.
  • 25.  Proximal muscle wasting & weakness  Osteoporosis  Glucose intolerance  HTN, hypokalemia  Thromboembolism  Depression, Psyc  Infection  Glaucoma
  • 26.  Removal of adrenal tumor if this is the cause  Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion