ADRENAL GLAND

PHYSIOLOGY
Anatomy
Adrenal Cortex
Adrenal Medulla

phenylethanolamine-N-

methyltransferase

Norepinephrine Epinephrine
Steroidogenesis
Steroidogenesis
Steroidogenesis
Steroidogenesis
Steroidogenesis

Congenital Adrenal Hyperplasia

- autosomal recessive disorder
due to deficiency or lack of an
enzyme in the synthesis of cortisol
Steroidogenesis
Steroidogenesis
3β
dehydrogenase
Steroidogenesis 17α
hydroxylase
Steroidogenesis 21- hydroxylase
Steroidogenesis 11- hydroxylase
Steroidogenesis
Synthesis & Release
Transport & Metabolism

Transport Proteins
 Corticosteroid-binding globulin
(CBG)
 Albumin
Transport & Metabolism

Cortisol Aldosterone
80% bound to CBG 60% bound to albumin
15% bound to albumin
5% free 40% free

t½ 90 mins t ½ 30 mins

Serum levels:
10-25μg/dl 2-10 ng/dl
Transport & Metabolism
Regulation - Glucocorticoids

Hypothalamus

CRH

Pituitary

ACTH

Adrenal Cortex

CORTISOL
Regulation - Glucocorticoids
Regulation - Glucocorticoids
Regulation-Glucocorticoids
Regulation-Glucocorticoids
Mechanism of Action-Glucocorticoids
Biologic Actions-Glucocorticoids
Biologic Actions-Glucocorticoids

Interaction of Hormones in Metabolism

post-prandial: regulatory hormone (insulin)
 cellular glucose uptake

early fasting: counter-regulatory hormones (E,G,GH,C)

 glycogenolysis; minimal glycolysis

late fasting: counter-regulatory hormones (E,G,GH,C)

 gluconeogenesis; lipolysis; protein degradation

long-term starvation
 ketogenesis
Biologic Actions-Glucocorticoids

Interaction of Hormones in Metabolism

long-term starvation: normal levels of counter-
regulatory
hormones
 ketogenesis
  protein degradation
  gluconeogenesis
  BMR
Biologic Actions-Glucocorticoids
Biologic Actions-Glucocorticoids
Biologic Actions-Glucocorticoids

Physiologic Effects
1. hepatic glucose production
2. protein catabolism
3. fat catabolism
4. increased bone resorption
5. altered mood
6. increased gastric acidity
7. PNMT synthesis
Biologic Actions-Glucocorticoids

Therapeutic Effects
1. prevents vascular collapse during stress
2. anti-inflammatory effect
Capillary dilation; prostaglandin/leukotriene
production; Leukocyte migration; stabilzation of
lysosomal membrane

3. invoking immunosuppression
- T cell proliferation; complement synthesis;
β cell killing
 i
g
u
Biologic Actions-Glucocorticoids r
e

1
2
.
1
3

F
i
g
u
r
e

1
Pathophysiology
Pathophysiology
Pathophysiology
Pathophysiology
Pathophysiology
Pathophysiology
Regulation-Mineralocorticoids
Regulation-Mineralocorticoids

Stimuli for Renin Secretion

 blood pressure
 serum Na
 blood volume
• ANS stimulation
Regulation-Mineralocorticoids
Regulation-Mineralocorticoids

Actions of Angiotensin II
2. Direct arteriolar vasoconstrictor
3. Stimulus to aldosterone secretion
Regulation-Mineralocorticoids
Biologic Actions-Mineralocorticoids

Aldosterone
MOA: transcription of enzymes and
proteins

Major actions: Na reabsorption in

distal tubule

Extrarenal effects: Na reabsorption in

saliva, sweat, stool
Pathophysiology

Hypersecretion of Aldosterone

1o aldosteronism – Conn’s syndrome

2o aldosteronism – liver/kidney disease

SXS: hypertension
hypokalemia
metabolic alkalosis
Pathophysiology

Primary Hyperaldosteronism
 ECF volume 
Aldosterone   Na retention  +  Renin
 Renal perfusion
pressure

Secondary Hyperaldosteronism
 Na retention
Renal perfusion   Renin   Aldosterone  +
pressure  ECF volume
Pathophysiology

Hyposecretion of Aldosterone

1o hyposecretion – Addisons’ dse

2o hyposecretion – kidney damage

SXS: hypovolemia
hyponatremia
hyperkalemia
Happy
New
Year!!
!
Anatomy
Anatomy
 i
g
u
Synthesis & Release r
e

1
2
.
1
3

F
i
g
u
r
e

1
Transport & Metabolism

Epinephrine Norepinephrine

t½ < 10 sec t½ < 15 sec

levels
20-50ng/ml 100-350 ng/ml
Transport & Metabolism
Regulation

Stimuli for Catecholamine Secretion

2. exercise, stress and anxiety
3. hypoglycemia
4. emergency situations
5. decreased blood pressure
6. decreased oxygen availability
Biologic Actions

Mechanism of Action of Catecholamines

β receptors : stimulates adenylate cyclase

α receptors : inhibits adenylate cyclase

Biologic Actions
 Biologic Actions

Factors Involved in Activation of Sympathetic Response

Sympathoadrenal System Sympathetic Nervous System
Signal Input Ach from preganglionic n Ach from preganglionic neuron

Major Secretory Epinephrine Norepinephrine

product

Stimuli for psychological stress, anxiety cold stress, exercise,

activation hypoxia, hypoglycemia postural hypotension

Major PSIO first line of defense vs first line of defense vs stress

effect stress (fight or flight) normal homeostatic
maintenance of CV sympathetic
tone

Hormonal kidney and liver presynaptic neuron (reuptake)

metabolism (metabolism)
Biologic Actions

Major Physiologic Effects:

cardiac output
• respiration
• blood flow to heart, muscles, brain, lungs
•  alertness
•  circulating glucose, FFA, lactic acid
Biologic Actions

Sympathetic Response “Fight of Flight”

Tissue Direct Response Physiological Outcome
Lungs respiration O2 to heart

Heart cardiac output blood/O2 to tissues

Vascular +/- regional blood preferential shunting of

smooth muscle flow blood

Skeletal contraction locomotion

muscle

Liver glycogenolysis glucose to tissues

Adipose tissuelipolysis FFA to tissues

Pathophysiology

Disorders of Adrenal Medulla

hyposecretion – hypofunction of adrenal gland

hypersecretion – benign pheochromocytoma;
malignant neuroblastoma

SXS: hypertension tremors

tachycardia anxiety
headache sweating
Pathophysiology

Therapeutic Uses of Catecholamines

Agonists Antagonists
Parkinson’s disease hypertension
clinical depression hyperthyroidism
shock cardiac arrhythmia
asthma angina pectoris
allergic reactions
nasal congestion
THANK YOU!