ANATOMY AND PHYSIOLOGY

Adrenal Glands Curved over the top of the kidneys, adrenal glands are structurally and functionally two endocrine glands in one. Like the pituitary gland, the adrenals have glandular (cortex) and neural tissue (medulla) parts. The central medulla region is enclosed by the adrenal cortex which contains three separate layers of cells. Hormones of the Adrenal cortex Major groups of steroid hormones such as mineralocorticoids, glucocorticoids and sex hormones are produced by the adrenal cortex. These hormones are collectively termed as corticosteroids.

Mineralocorticoids

1. Produced by the outermost layer of the adrenal cortex, the mineralocorticoids, are mainly aldosterone. These hormones play an essential part in regulating the mineral or salt content of the blood particularly the concentrations of sodium and potassium ions. The target organ of the hormone is the kidneys that selectively reabsorbs the minerals or allow them to be flushed out in the body in the form of urine. 2. Increased aldosterone levels in the body would result to rising amounts of reclaimed sodium ions by the kidney tubules and secreting more potassium ions into the urine. When sodium is reabsorbed water follows. Hence, the mineralocorticoids aids in water and electrolyte regulation. 3. Aldosterone is also released when the kidneys produce the enzyme, renin, when blood pressure drops. Production of renin triggers a series of reactions

that form angiotensin II, which is a potent stimulator of aldosterone release. 4. To prevent aldosterone release, atrial natriuretic peptide or ANP is released by the heart. The main goal of releasing ANP is to reduce blood volume and blood pressure.

Glucocorticoids

Glucocorticoids are produced by the middle layer of adrenal cortex which includes contisone and cortisol. The functions of this hormone are: 1. Promotion of normal cell metabolism 2. Helping the body resist long-term stressors, by increasing blood glucose levels. Important information about glucocorticoids: 1. Fats and even proteins are broken down by body cells and converted to glucose when blood levels of glucocorticoids are elevated in the blood. Hence, these hormones are said to be hyperglycemic hormones. 2. Unpleasant effects of inflammation are also controlled by glucocorticoids as they reduce the effects of edema and they reduce the pain by inhibiting some pain-causing molecules called prostaglandins. Thus, because of their anti-inflammatory properties, glucocorticoids are often prescribed as drugs to suppress inflammation for patients with arthritis. 3. Glucocorticoids are released from the adrenal cortex in response to the rising blood levels of ACTH.

Sex Hormones

The adrenal cortex produces the sex hormones regardless of ones gender. Production of sex hormones takes place throughout a persons life but the amount formed is relatively small. It is the innermost layer of the cortex that produces a large amount of androgens, male sex hormones and some estrogen, female sex hormone. Hormones of the Adrenal Medulla Like the knot of nervous tissue where posterior pituitary gland develops, the adrenal medulla has the same development. When this structure is stimulated by the sympathetic nervous system neurons, epinephrine, also called adrenaline, and norepinephrine, otherwise known as noradrenaline, are released into the bloodstream. Collectively, these hormones are called catecholamines.

1. Physical or emotional stress and threat would bring about the fight-or-flight response. The response is necessary to help a person cope up with the stressful situation. One of the organs stimulated in these situations is the adrenal medulla which is responsible for pumping catecholamines or hormones into the bloodstream to enhance and prolong the effects of neurotransmitters of the sympathetic nervous system. 2. Presence of catecholamines has the following effects: increased heart rate, elevated blood pressure and rising blood glucose levels. Also, small passageways of the lungs are dilated with presence of these hormones to cater more oxygen in the blood and a faster circulation to the organs most importantly to the brain, heart and muscles. Increase glucose and oxygen would make the body fit to fight or deal with short-term stressors.

Stretch marks Around the waist (trunchal obesity) Back of the head (Buffalo Hump)

Thining of the hair

Thining of the skin

Face (moonfac e)

Vasoconstricti on of blood vessel

Protein wasting

Fat deposition Appetite

enhancement of vasoconstrictive effect of circulatory catecholamine

Sensitivation of A- adrenergic receptors on surface of smooth muscle

Protein catabolism Protein Breakdown

Stimulation of satiety center (hypothalamus)

PATHOPHYSIOLOGY

Defect in gene coding for p53 and p57 Tumor formation arising from adrenal gland affecting both medulla and cortex (ADRENAL ADENOMA)

ADRENAL MEDULLA Formation of Tumor composing of chromffin cells (PHEOCHROMOCYTO MA) Release of catecholamines (norepenephrine and epinephrine) in the blood Release of catecholamines (norepenephrine and epinephrine) in the blood

ADRENAL CORTICAL ADENOMA Stimulation of Melanin synthesis Stimulation of androgen synthesis Virilization Hypersecretion of cortisol

Stimulation of Aldosterone synthesis Hyperaldosteroni sm Hyperaldosteroni sm Na & H20 retention Stimulation of alpha adrenergic receptors High blood pressure

Hyperpigmentati on of skin

Hypercortisoli sm/ CUSHINGS SYNDROME Acne Hirsutis m

Darkened striae

Darkene d skin

Irregular, fluctuating , and small in amount but constant menstruati

Weight gain