Adrenal Gland

ADRENAL GLANDS

By Sara Sami Yuzuncu Yil University

2015

ADRENAL GLANDS

• Adrenal Cortex• Adrenal Medulla

ADRENAL CORTEX

• Salt• Sugar• Sex

SALT

• Mineralocorticoids (F & E balance)– Aldosterone (renin from kidneys controls adrenal

cortex production of aldosterone)• Na retention • Water retention• K excretion

SUGAR• GLUCOCORTICOIDS (regulate metabolism & are critical in stress

response)– CORTISOL responsible for control and &

metabolism of:a. CHO (carbohydrates)

– glucose formed– glucose released

CORTISOLFATS-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

• Other fxs of Cortisol– inflammatory and allergic

response

– immune system therefore prone to infection

SEX• ANDROGENS– hormones which male characteristics

• release of testosterone

• Clear more in women than men

•                   Adrenal cortex

Glucocorticoids   mineralocorticoids    sex

Hydro cortisone    corticosterone                              

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.

RELEASE OF GLUCOCORTICOIDS IS CONTROLLED BY ______

LET’S LOOK AT ACTH

(adrenocorticotropic Hormone)

• Produced in anterior pituitary gland

ACTHcortisol

–   levels cause stimulation of ACTH

–    levels cause dec. release of ACTH

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

• 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

The Adrenal GlandIn 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

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.

– 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,

SIGNS & SYMPTOMSHyperaldosteronism

• Na and water retention–H/A, HTN

• K+ (hypokalemia)• What is the normal serum K+ level???• Usually no edema

DIAGNOSIS-Hyperaldosteronism

•       urinary K

• plasma aldosterone levels with low plasma renin levels

• CT scan• EKG changes

INTERVENTIONSHyperaldosteronism

•        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

– 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

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

Reticularis

1. Permissive effect on glucagon2. Memory, learning & mood 3. Gluconeogenesis4. Skeletal muscle breakdown5. Lipolysis, calcium balance6. Immune depression7. Circadian rhythms

Cortisol Effects: Body Responses To Stress

• 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

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. 

ADRENAL INSUFFICIENCY

Adrenal Gland Disorders

Some examples include:

1. Cushing's Syndrome 

2. Congenital Adrenal Hyperplasia 

3. Pituitary Tumors 

CUSHING’S SYNDROME

• Hypersecretion of cortisol caused by endogenous production/excessive use of corticosteroids

CLINICAL SYMPTOMS 

• Weight gain / central obesity• Diabetes• Hirsutism• Hypertension• Skin changes ( abd striae, facial plethora, ecchymosis, acne)

• Muscle weakness• Depression / mania• Osteoporosis• Hypokalemia

DIAGNOSIS 

• Morning and midnight plasma cortisol levels are elevated 

• Dexamethasone fails to suppress 24-hour urinary cortisol excretion.

• Serum ACTH level

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. 

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.

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

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.

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. 

• Replacing aldosteroneFludrocortisone 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 

TREATMENTAddisonian Crisis

• Rapid infusion of IV fluids• Check VS and urine output frequently• Monitor EKG• Give solu-cortef IV Q6 hours until S & S

disappear

TREATMENT

• Try to decrease anxiety• May have to give vasopressors– Dopamine or Epinepherine

• Avoid additional stress

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

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.

• Drugs that stimulate the sympathetic nervous system (SNS)

So its  Also known as• adrenergic agonists or sympathomimeticsnorepinephrine (NE) and epinephrine (EPI)

Thank you for your attention