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Summaries :
Anatomy of the supra renal gland
N.B: Each Gland is formed of 2 parts cortex (secretes steroids) and medulla
(secretes catecholamines).
Relations:
Post. : Diaphragm
Ant:
Right Left
Partially peritoneum Covered by peritoneum of lesser
sac
IVC Pancreas
Liver Splencic vessels
Arterial supply:
Venous drainage:
Origin:
A) Cortex:
Proliferation of Ceolemic epithelium.1ry fetal cortex.invade the
medulla..proliferates again..2ry fetal cortex
MesodermCt capsule.
B) Medulla:
Neural crest..sympathetic ganglion
Neuroectodermal cells migrateinvade the 1ry cortex and give the suprarenal
medulla.
Congenital anomalies:
1. Ectopic suprarenal gland
1. Cortex: Yellow peripheral part, has the same origin as the gonads and secrete
steroid hormones.
2. Medulla: Reddish brown central layer has origin same as the sympathetic nervous
system and secrete catecholamines.
A) Stroma:
The gland is covered by a C.T capsule that sends thin trabecullar septa inside the
gland. A network of reticular fibers supports the secretory cells.
B) Medulla:
1. Chromaffin cells.
1) Chromaffin cells:
cytoplasm.
C) Cortex:
Manifestations:
The hypertension is associated with increased risk of myocardial ischemia,
congestive heart failure, renal injury, and cerebrovascular accidents. Sudden
death may occur.
Tachycardia.
Palpitation.
Hyperglycemia.
Increase in basal metabolic rate.
Mineralocorticoids
Aldosterone is a steroid.
It is secreted from the zona glomerulosa.
It combines loosely with the plasma proteins.
Functions of the mineralocortocoid (Aldosterone):
On Kidney
Aldosterone increase sodium reabsorption in exchange with secretion of either K+
or H+. hi the distal tubules, collecting tubules and collecting duct. It increases
formation of Na* K+ATPase.
1. Glucocorticoids
2. Androgens
1. Glucocorticoids
Steroid hormones ( group I ) so:
a. They bound to plasma proteins ( transcortin)
b. 94% bound inactive . 6% free active
c. They bound to cytoplasmic & nuclear receptors >> transcription &
translation of mediators
d. Mediators of metabolic actions >> enzymes ( cAMP dependant kinase)
e. Mediators of anti-inflammatory & immunosuppressive actions >> lipocortin
lipomodulin leading to:
i. Inhibitions of phospholipase A2 >> inhibition of PGs &
leukotriens formation
ii. Inhibition of platelet activating factor synsthesis
iii. Inhibition of mediator release from inflammatory cells
Metabolic actions:
Hyperglycemic . Catabolic lipolytic
a. Hyperglycemic:
1. Increase gluconeogenesis in the liver by:
i. Increasing enzyme synthesis
ii. Increasing mobilization of aminoacids from extrahepatic tissues (
muscles ) >> blood >> liver
2. Decreasing glucose utilization by the cells by decreasing glucose
transport
3. Hyperglycima >> worsen diabetes
b. Catabolic:
1. Decreasing proteins in extrahepatic tissues by:
i. Decreasing protein synthesis
ii. Increasing protein catabolism
iii. Decreasing aminoacid transport to extrahepatic tissues
2. Increasing protein synthesis in the liver by
Increasing mobilization of amnioacids to the liver >> elevating blood amniacid level
Increasing FFA mobilization from adipose tissues increasing their plasma level and
their utilization for energy
Circulatory actions:
1. Important for normal muscular contractility & vasoconstrictive effect of NE
2. Decreasing vascular permeabiliting preserving blood volume
Nervous actions:
Muscular actions:
1. Important for normal contractility
2. Deficiency >> muscular fatigue
3. Excess >> muscular atrophy due to increased protein catabolism
Actions on Ca++ metabolism:
Decreasing plasma Ca++ level by
1. Decreasing Ca++ & PO4-- intestinal absorption (anti Vitamin D action)
2. Increasing renal excretion
Decreasing bone formation by
1. Inhibition of cellular replication of osteoblasts & protein synthesis
Immunosuppressive actions:
1. Increasing RBCs
2. Decreasing eosinophils , basophils , monocytes & lymphocytes
3. Large doses :
a. Atrophy of lymphoid tissue
b. Decreased T & B cells
c. Decreased level of immunity
Anti-inflammatory & anti allergic actions:
1. Rapid resolution
2. Decreasing vascular permeability
3. Decreasing inflammatory cells & release of mediators
4. Stabilization of lysosomes ( decreasing release of proteolytic enzymes)
5. Inhibition of fibrosis & adhesions
2. Androgens
1. During fetal life:
Androgens are continuously secreted from adrenal cortex + minute
amounts of female sex hormones
Part of early development of male sex organs due to childhood
release of androgens
2. In females much of the growth of pubic & axillary hair due to cortical
androgens
3. In males part of cortical androgens in converted into testosterone in
extracortical tissue secretion is controlled by ACTH
Diseases of adrenal cortex
Summary of Pathology
Adrenal Medulla diseases
Pheochromocytoma Neuroblastoma
Description It is derived from chromaffin cells. A highly malignant
Most of the tumors arise from the adrenal medulla. tumor.
However, in a minority of cases, the tumor arises in Neuroblastoma most
extra adrenal sites eg. sympathetic ganglia called commonly arises in
paragangliomas. either the adrenal
medulla or the
retroperitoneal
sympathetic ganglia.
Most neuroblastomas
secrete catecholamines.
Pheochromocytomas occur sporadically (90%), or as Most of the cases are
Incidence
a part of multiple endocrine syndrome. sporadic; however,
Most sporadic lesions occur in adulthood with slight familial cases also occur.
female prevalence; familial lesions may arise in
childhood, with strong male predominance.
b. Secondary hyperaldosteronism
It occurs in response to activation of the renin-angiotensin system. It is
characterized by increased level of plasma renin.
Corticosteroids include:-
o Glucocorticoids (cortisol)
o Mineralocorticoids (aldosterone)
ACTH controls only cortisol and androgens, So :-
o In case of impaired secretion of ACTH use only glucocorticoids
o If suprarenal gland is damaged give both (glucocorticoids and
mineralocorticoids)
Preparations :-
that secrete
chatecholamines
e. None of the above
10. The granules of the 13. Which of the following is not
chromaffin cells secreting true Zona glomerulosa :
norepinephrine are: a. It forms 15% of the total
a. Large volume of the gland
b. Small b. It lies immediately under
c. Have an eccentric electron- the stroma
dens core within the limiting c. Has closely packed cells
membrane of the granules surrounded by blood
d. Have a less electron-dens capillaries
core filling the granules d. The cells in this zone are
e. A & C columinar or pyramidal in
f. B & C shape with dense basal
g. A & D acidophilic nuclei
e. The cells in this zone have
11. Secretion of catecholamines is smooth ER, mitochondria
intiated by acetylcholine released with tubular cristea and
from preganglionic sympathatic filled with lipid droplets
fibers in the splanchnic nerves f. None of the above
a. True
b. False 14. Which of the following
12. Which of the following is not statements is correct :
true about the adrenal cortex : a. The cells of Zona
a. Its the yellowish prepheral glomerulosa are responsible
layer of the adrenal gland for the secretion of
b. Its mesodermal in origin glucocorticoids
c. It secretes the steroid b. The cells of Zona fasciculata
hormones are responsible for the
d. Its divided into 3 zones, secretion of androgens
Zona glomerulosa, Zona c. The cells of Zona
fasciculata and Zona glomerulosa are responsible
reticularis for the secretion of
e. None of the above aldosterone
d. The cells of Zona reticularis 17. Which of the following is a
are responsible for the common feature between cells of
secretion of adrogens Zona glomerulosa and that of
e. A & B Zona reticularis:
f. C & D a. They both have acidophilic
cytoplasm
15. Which of the following is the b. They both have few lipid
largest layer of the cortex: droplets
a. Zona glomerulosa c. They are both surrounded
b. Zona fasciculata by fenestrated blood
c. Zona reticularis capillaries
d. Non of the above d. They both have
mitochondria with lamellar
16. Which of the following is not cristea
true about the cells in Zona e. A & B
fasciculata : f. A & C
a. They are arranged into
cords perpendicular to the 18. Which of the following is not
surface separated by a common feature between cells
longitudinally arranged of Zona fasciculata and that of
fenestrated blood capillaries Zona reticularis :
b. They are large polyhedral a. They both have lipid
with large, pale round nuclei droplets
c. Unlike the cells in Zona b. They both have acidophilic
glomerulosa they contain cytoplasm
numerous vacuoles as well as c. They both have smooth ER
numerous lipid droplets d. They both secrete
d. They secrete glucorticoids glucocorticoids
unlike the cells of the other e. Non of the above
zones of the adrenal cortex
e. Non of the above
19. Glucocorticoids are secreted 23. The net effect of cortisol on
from : protein metabolism :
a. Zona glomrulosa a. Increase plasma protein
b. Zona fasciculata synthesis
c. Zona reticularis b. Increase liver catabolism of
d. Adrenal medulla protein
c. Decrease amino acid level in
20. Percentage of cortisol bound blood
to plasma protein is : d. Increase protein synthesis
a. 80 % in muscle
b. 94% 24. The lipolytic effect is caused
c. 6 % by all except :
d. 20 % a. GH
b. Thyroxine
21. One of the following has c. Insulin
different action on glucose level d. Cortisol
of blood from others :
a. Growth hormone 25. All of the following are
b. Insulin effects of cortisol except :
c. Adrenaline a. Increase free fatty acids in
d. Glucocorticoids blood
b. Maintains blood volume
22. All of the following are c. Enhance Vasoconstrictive
effects of glucocorticoids on d. Increase Utilization of
protien except : glucose
a. Mobilization of amino acids
from extrahepatic tissues 26. Cortisol is essential for all of
b. Reduce protein synthesis in the following except :
stomach a. Muscular activity
c. Reduce protien synthesis in b. Inflamation mechanism
liver maintenance
d. Increase catabolism of c. Nervous function
protein in muscle d. Glucose level
27. Effect on cortisol is like
calcitonin and parathormone at 30. Feedback mechanism of
the same time ,, which of the cortisol acts directly on :
following statements explain this a. Hypothalamus
? b. Pituitary gland
a. Increase Ca excretion ,, and c. Adrenal cortex
bone Ca deposition d. Both (a) and (b)
b. Increase Ca absorption and
bone formation 31. All of the following hormones
c. Increase Ca excretion and are released simultaneously with
bone resorption ACTH except :
d. Decrease Ca absorption and a. Lipotropin
bone resorption b. MSH
28. All of the following are c. Endrophin
effects of cortisol on inflamation d. Liponectin
except :
a. Increase stability of 32. Stress increases cortisol
lysosomal membranes secretion through acting directly
b. Increase permeability of on :
capillaries a. Hypothalamus
c. Decrease number of b. Anterior pituitary gland
inflamatory cells c. Adrenal cortex
d. Rapid resolution of d. All of the above
inflamation
33. Cortisol is highest in :
29. ACTH long term stimulation to a. Noon
adrenal cortex leads to increase b. Early morning
proliferation of adrenal cortex c. Evening
significantly except : d. Midnight
a. Zona reticularis
b. Zona fasiculata
c. Zona Glomerulosa
d. None of the above
34. All of the following is true 38. Catecholamines cause
about androgens except : vasodilation to the renal blood
a. Exert slight masculinizing vessels so increase urine volume
effect on female throughout a. True
life b. False
b. Some are converted to
testosterone 39. All of the following stimulate
c. Controlled by ACTH the secretion of catecholamines
d. Starts to be secreted at except :
the beginning of puberty a. Muscular exercise
b. Haemorrhage
35. All of the following actions c. Hyperglycemia
are produced in stress due to d. Exposure to cold
catecholamines secretion except
: 40. Catecholamines have only a
a. Increase the metabolic rate direct effect on respiratory
b. Increase heart rate centre to increase the depth &
c. Vasoconstriction of skeletal rate of respiration
muscle blood vessels a. True
d. Increase the visual field b. False
36. All of the following are
hyperglycemic hormones except 41. All of the following are
a. Catecholamines manifestation of
b. Growth hormone pheochromocytoma except
c. Thyroid hormone a. Tachycardia
d. Prolactin b. Palpitation
c. Hypotension
37. All of the following are true d. Hyperglycemia
about catecholamines except :
a. Stress hormone
b. Hyperglycemic
c. Calorigenic
d. Steriods
42. .. Is the dominant clinical 46. Aldosterone decrease loss of
manifestation of salt in
pheochromocytoma a. Stools
a. Hypertension b. Sweat
b. Hypoglycemia c. Saliva
c. Bradycardia d. All of the following
d. Tachycardia
47. in potassium ion
43. All of the following are true concentration causes direct
about aldosterone except stimulation of zona glomerulosa
a. Mineralocorticoid to increase secretion of
b. Na+ and K+ metabolism aldosterone
regulator a. Decrease
c. Protien in nature b. Increase
d. Secreted by zona c. Non of the above
glomerulosa
48. All of the following stimulate
44. Aldosterone acts on . secretion of aldosterone except
Receptors on kidney a. Increase in K+
a. Cytoplasmic b. Increase in Na+
b. Nuclear c. Hypovolemia
c. Palasma membrane d. Unidentified pituitary
d. Non of the above factor