Adrenal Gland: Adrenal Cortex Adrenal Medulla

ADRENAL GLAND
ADRENAL CORTEX
ADRENAL MEDULLA
Goals for learning

Functional anatomy of adrenal gland
Hormones and their synthesis
Functions of the hormones
Cellular mechanism
Regulation of their secretion
Effect of their altered secretion
Adrenal gland
Adrenal
cortex
Zona glomerulosa-Mineralocorticoid
Aldosterone, Deoxycorticosterone
Zona fasciculata-Glucocorticoids
Cortisol, Corticosterone, Cortisone

Zona reticularis-Adrenal androgens
Androsterone, DHEA sulphate
Adrenal Medulla
Epinephrine
Nor epinephrine
Dopamine
Cholesterol
Pregnenolone
17 OH Pregnenalone
DHEA
Progesterone
17 OH Pregnenalone
Andro
stenedione
11 Deoxy
Corticosterone
Corticosterone
11 Deoxycortisol
Testosterone
Cortisol
Estradiol
Glucocorticoids
Cortisol
Corticosterone
Cortisone
Predinisolone
(synthetic)
Dexamethasone (synthetic)
Concentration
of cortisol is 13.5
microgram/100 ml,
Secretion 15-20mg/day
Transport
Cortisol binding globulin(CBG)/ transcortin
GLUCOCORTICOIDS
CORTISOL
This
is a C21 steroid produced mainly from zona

fasciculata.
It combines with cortisol binding globulin.
96 % of the cortisol is transported in bound form.
Only 4 % is transported in free form.
It stays in circulation for 1 to 2 hours.
It is degraded in the liver and conjugated to form
glucuronides. It is excreted in urine.
MECHANISM OF ACTION
These
hormones enter the cell and combine with

receptors in the cytoplasm. Hormone receptor
complex induces portion of DNA to form m
RNA.
The m RNA causes protein formation. These
proteins are responsible for actions of
glucocorticoids.
Onset of action is 45-60 min
Functions
Metabolism
CHO, Proteins, Lipids, Mineral and Water

Permissive Action
Effect on ACTH secretion
Vascular permeability
On Nervous System
On Blood cells and Lymphatic organs
Resistance to Stress
Anti inflammatory and Antiallergic Effects
On carbohydrate metabolism
It
stimulates gluconeogenesis by the liver by

increasing glucose-6-phosphatase.
It decreases rate of glucose utilization by the
peripheral tissues by inhibiting phosphorylation
(anti-insulin action)
Increases glycogen synthesis in liver by increasing
activity of glycogen synthase.
On protein metabolism
It
causes protein breakdown in skeletal

muscles.
Cortisol enhances amino acid uptake by the
liver cells & enhances transamination - (AA
synthesis), deamination (glucose
formation)
Hence proteins like plasma proteins
produced by liver are increased
On fat metabolism
It
causes fatty acid mobilization from

adipose tissue increasing free fatty acids in
plasma.
It stimulates absorption of lipids from the
intestine.
It causes redistribution of fats in the body.
Water and Mineral metabolism

Mild
mineralocorticoid activity retains Na

& excretes K
Increases angiotensinogen synthesis in liver
leading to Na retention via aldosterone
Provides adequate GFR via anti-ADH
activity
Permissive action
On
glucagon & catecholamines to exert

calorigenic action
On catecholamines to exert lipolytic effect
& glycogenolytic effect.
On catecholamines to exert pressor
response & bronchodilation.
In stress
Offers
resistance to Stress
Stress causes increase in ACTH secretion
followed by secretion of cortisol
Stress causes General Adaptation Syndrome in
2 phases:
1 Stage of Alarm
2 Stage of Resistance: in which cortisol
interacts with catecholamines activation of
sympatho-adrenal medullary system.
Effect on blood cells

Eosinopenia
Lymphopenia
Basopenia
Neutrophilia
Polycythemia
Platelet count
It
On Bone
causes demineralization of bone

Retards development of cartilage
Thinning of epiphyseal plate
Breaks down bone matrix
Decreases calcium deposition
Increases calcium excretion
Decreases calcium absorption from GIT
Results in osteoporosis and tetany
Anti inflammatory & Antiallergic

Effect
Pharmacological
doses
Inhibits Phospholipase A2
Reduces the release of arachidonic acid &
consequently reduces the formation of leukotriens,
thromboxanes, prostaglandins and prostacyclins.
It reduces leucocyte margination, chemotaxis,
phagocytosis of bacteria.
It prevents development of fibroblasts & delays
wound healing
REGULATION
Cortisol
secretion is controlled by ACTH.

ACTH is secreted in irregular bursts
throughout the day. Plasma cortisol rises and
falls in response to these bursts. Plasma
cortisol is high in mornings (20mg/dl ) and
very low (5mg/dl) in evenings.
Trauma
Afferents
from NTS
Emotions
Circadian rhythm
CRH
cortisol
ACTH
Adrenal cortex
CUSHINGS SYNDROME
Excess
secretion of glucocorticoids.
Causes
Adrenocortical tumours
Anterior pituitary tumours
Ectopic ACTH producing tumour
Prolonged glucocorticoid therapy.

Cushings syndrome caused due to tumours of
anterior pituitary is called Cushings disease.
Signs & symptoms

Fat
collects in the abdominal

wall, face and upper back
producing buffalo hump and
moon face.
Skin and subcutaneous tissues
are thin.
Muscles are poorly
developed.
Wounds heal poorly, minor
injuries cause bruises
Osteoporosis occur.
There is insulin resistant
diabetes mellitus due to
gluconeogenesis .
There
Signs & symptoms
is salt and water

retention, K+ depletion and
weakness due to
mineralocorticoid activity of
cortisol .
Protein depletion occurs due
to its excessive catabolism.
Hypertension develops due
to increased
deoxycorticosterone
production.
Reddish purple striae appear
in the skin due to rupture of
subdermal tissues
Treatment
Removal
of tumour in adrenal or pituitary
gland.
If removal of pituitary tumour is not
possible, then removal of both adrenals with
supplementation of steroids.
Summary
Hormones
of Adrenal Cortex
Glucocorticoids-Mechanism, Functions
Cushings Syndrome
Study questions
Name
the layers of adrenal cortex and list the

hormones secreted by them
Describe the functions of glucocorticoids
What is permissive action of a hormone. Give
suitable example?
Discuss the anti-inflammatory functions of
glucocorticoids
Explain the cause and clinical features of
cushings syndrome

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ADRENAL GLAND

Goals for learning

Cortisol, Corticosterone, Cortisone

is a C21 steroid produced mainly from zona

hormones enter the cell and combine with

CHO, Proteins, Lipids, Mineral and Water

stimulates gluconeogenesis by the liver by

causes protein breakdown in skeletal

causes fatty acid mobilization from

Water and Mineral metabolism

mineralocorticoid activity retains Na

glucagon & catecholamines to exert

Effect on blood cells

causes demineralization of bone

Anti inflammatory & Antiallergic

secretion is controlled by ACTH.

Anterior pituitary tumours

Ectopic ACTH producing tumour

Prolonged glucocorticoid therapy.

anterior pituitary is called Cushings disease.

Signs & symptoms

collects in the abdominal

Signs & symptoms

is salt and water

of tumour in adrenal or pituitary

the layers of adrenal cortex and list the

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