Biokim Adrenal

The adrenal cortex

The adrenal cortex consists of layers of epithelial cells and associated capillary tissue. This layer forms
three distinct regions: an outer glomerulose zone that produces mineralocorticoids, a medium
fasciculate zone that produces glucocorticoids, and an inner reticularis zone that produces androgens,
which are sex hormones that promote masculinity.

The main mineralocorticoid is aldosterone, which regulates the concentration of sodium ions in urine,
sweat, pancreas, and saliva. Aldosterone released from the adrenal cortex is stimulated by a decrease in
blood sodium ion concentration, blood volume, or blood pressure, or by increasing blood potassium
levels.

Glucocorticoids regulate the increase in blood glucose and also reduce the body's inflammatory
response. The three main glucocorticoid hormones are cortisol, corticosterone, and cortisone.
Glucocorticoids stimulate glucose synthesis and gluconeogenesis (converting non-carbohydrates into
glucose) by liver cells. They also increase the release of fatty acids from adipose tissue. These hormones
increase blood glucose levels to maintain levels in the normal range between meals. Cortisol is one of
the most active glucocorticoids. Usually reduce the effects of inflammation or swelling throughout the
body. It also stimulates the production of glucose from fats and proteins, which is a process called
gluconeogenesis. Aldosterone is one example of a mineralocorticoid. It provides tubular signals in the
kidney nephron to reabsorb sodium while secreting or eliminating potassium. If sodium levels are low in
the blood, the kidneys secrete more renin, an enzyme that stimulates the formation of angiotensin from
molecules made from the liver. Angiotensin stimulates aldosterone secretion. As a result, more sodium is
absorbed because it enters the blood. Aldosterone, the main mineralocorticoid, stimulates the distal
renal tubular cells of the kidney to reduce potassium re-absorption and increase sodium re-absorption.
This in turn causes an increase in re-absorption of chloride and water. These hormones, together with
hormones such as insulin and glucagon, are important regulators of the ionic environment of internal
fluids.

The adrenal medulla

The adrenal medulla contains two types of secretory cells: one that produces epinephrine (adrenaline)
and another that produces norepinephrine (noradrenaline). Epinephrine is the main medulla adrenal
hormone, accounting for 75 to 80 percent of secretions. Epinephrine and norepinephrine increase heart
rate, respiratory rate, heart muscle contraction, blood pressure, and blood glucose levels. They also
accelerate the breakdown of glucose in skeletal muscle and fat stored in adipose tissue.

The release of epinephrine and norepinephrine is stimulated by nerve impulses from the sympathetic
nervous system. The secretion of this hormone is stimulated by acetylcholine released from the pre-
ganglionic sympathetic fibers innervating the adrenal medulla. Nerve impulses originate in the
hypothalamus in response to stress to prepare the body for a fight-or-flight (emergency) response.

Precocious puberty

Precocious puberty is a condition of the appearance of physical and hormonal signs in the form of
secondary sexual development before the age of 8 years in girls, and 9 years in boys. Precocious
puberty often has both physical and psychological adverse effects on children, as well as psychological
stress on the families who experience it.

Practically, precocious puberty can be classified into "normal" (considered non-pathological) and
pathological variants. "Normal" variants include telarke and early adrenarche / pubarke. At this time both
conditions are considered to not require therapy and are said to be self limiting. Whereas pathological
precocious puberty is divided into GnRH (Gonadotropin-Releasing Hormone) or central type, and does
not depend on GnRH or peripheral type (pseudopubertas).

The prevalence of precocious puberty is estimated at 1: 5000 to 1: 10,000, with a tendency for women to
be more than men.

Clinical Symptoms

- Increased growth rate

- The appearance of axillary hair and pubic hair

- Oily face and pimples

- Changes in muscle mass

- The emergence of adult body odor

- Increased appetite

- Breast development and genitalia

Diagnosis

• The first step to assess a child with precocious puberty includes history and family history: birth weight,
onset of age at the onset of puberty and at the speed of physical change, development of secondary
sex characteristics, steroid sex exposure and substances that interfere with endocrine disrupting
chemicals - EDCs), and evidence of possible central nervous system (CNS) dysfunction in headaches,
enlarged head circles, visual disturbances or seizures, trauma, and infections. Anamnesis that is also very
important is the height of the child compared to his peers: whether including the highest compared to
peers, or whether it seems there is a faster increase in height.
•Growth rate. Value whether there is an acceleration of linear growth by using a growth curve.

• Hormone profile. The gold standard of biochemical diagnosis is based on the assessment of
gonadotropins, especially LH, after stimulation with GnRH; however, due to limited availability GnRH
agonists can be used instead, which utilizes the initial stimulatory effect on the hypothalamic-pituitary-
gonad axis after a single dose of the GnRH agonist. Examination of blood specimens includes: LH, FSH,
Estradiol (using the Chemiluminescence assay method) or Testosterone (using the
Electrochemiluminescence immunoassay-ECLIA method)

Cushing Syndrome

There are 3 types of checks that can be used.

1. Examination of plasma cortisol levels

Under normal circumstances plasma cortisol levels correspond to circadian rhythms or diurnal periods,
ie in the morning plasma cortisol levels reach 5 - 25 Ug / dl (140-160 mmol / l) and at night it will
decrease to less than 50%.

2. Examination of free cortisol or 17-hydroxicorticosteroid levels in urine 24 hours

In Cushing's syndrome free cortisol levels and 17-hydroxicorticosteroids in the urine 24 hours increase.
3. Adrenal suppression test (single dose dexamethasone suppression test)

Dexamethasone 0.3 mg / m2 was given orally at 23:00, then at 08.00 the next day plasma cortisol levels
were examined. If the plasma cortisol level is <5 Ug / dl, there has been an emphasis on plasma cortisol
secretion and the conclusion is normal. In Cushing's syndrome plasma cortisol levels> 5 Ug / dl.