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THE ADRENAL GLAND D. C. MIKULECKY PROFESSOR OF PHYSIOLOGY AND FACULTY MENTORING PROGRAM THE ADRENAL GLANDS CORTEX: STEROID HORMONES SECRETED MEDULLA: CATECHOLAMINES (EPINEPHRIN AND NOREPINEPHRIN) SECRETED. IT IS A MODIFIED SYMPATHETIC GANGLION CORTEX: STEROID HORMONES SECRETED MINERALOCORTICOIDS GLUCOCORTICOIDS SEX HOMONES STEROID HORMONES CHOLESTEROL IS A COMMON PRECURSOR PREGNENOLONE IS A COMMON INTERMEDIATE DERIVATIVES OF THE POLYCYCLIC PHENANTHRENE NUCLEUS IMPORTANCE OF STEROID HORMONES: REMOVAL OF CORTEX LEADS TO DEATH WITHIN 1 OR 2 WEEKS WITHOUT REPLACEMENT THERAPY EVERY ORGAN SYSTEM IS AFFECTED MINERALOCORTICOIDS ALDOSTERONE ELECTROLYTE BALANCE BLOOD PRESSURE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM ALDOSTERONE SECRETION REGULATED BY RENIN SECRETION IN THE KIDNEY VIA ANGIOTENSIN II NEGATIVE FEEDBACK CONTROL VIA MONITORING BLOOD VOLUME GLUCOCORTICOIDS CORTISOL GLOCONEOGENESIS PERMISSIVE ACTIONS STRESS ADAPTATION ANTI-INFLAMITORY AND IMMUNOSUPPRESSANT SEE TABLE I IN TEXT PERMISSIVE ACTION OF CLUCOCORTICOIDS STRESS INCREASES OUTPUT OF ACTH FROM THE PITUITARY THESE HORMONES SEEM TO GOVERN PROCESSES FUNDAMENTAL TO NORMAL FUNCTION IN MOST CELLS TREATED AN ADRENALECTOMIZED ANIMAL PERMITTED THE RESUMPTION OF THESE FUNCTIONS (HANS SELYE, 1930’S) EFFECTS OF GLUCOCORTICOIDS ON ENERGY METABOLISM MAINTAIN CARBOHYDRATE RESERVES HYPOGLYCEMIA IF ABSENT GLUCONEOGENESIS: DIRECT EFFECTS AND INCREASES IN ENZYMES DECREASE UTILIZATION OF GLUCOSE BY MUSCLE AND ADIPOSE TISSUE AND LOWER SENSITIVITY TO INSULIN. DIABETES MAY ACCOMPANY CUSHING’S DISEASE WHICH IS A HYPERSECRETION ANTI-INFLAMITORY EFFECTS OF GLUCOCORTICOIDS INFLUENCE ON PROSTAGLANDINS: SUPPRESS SYNTHESIS OF CYCLOOXYGENASE POSSIBLY INHIBIT HISTAMINE FORMATION CYTOKINES (INTERLEUKIN-1) GLUCOCORTICOIDS AND THE IMMUNE RESPONSE BLOCK CYTOKINE PRODUCTION MAY ALSO KILL T-CELLS REGULATION OF CORTISOL SECRETION HYPOTHALAMUS STRESS + CRH + - DIURNAL RHYTHM ANTERIOR PITUITARY INCREASED BLOOD GLUCOSE BLOOD AA BLOOD FATTY ACIDS ACTH - ADRENAL CORTEX CORTISOL TARGET ORGANS ACTION OF ACTH STIMULATES STEROIDOGENESIS INCREASES STEROID SECRETION WITHIN 1 TO 2 MINUTES PEAK RATES IN ABOUT 15 MINUTES cAMP ---> PROTEIN KINASE A ABSENCE LEADS TO ATROPHY OF INNER ZONES OF ADRENAL CORTEX SEX HOMONES ANDROGENS (TESTOSTERONE) ESTROGENS LESS THAN GONADS ADRENAL STEROID HORMONES IN THE BLOOD BOUND TO TRANSCORTIN OR CORTICOSTEROID BINDING GLOBULIN (CBG) SECRETED BY LIVER BUT AT 1/1000 TH THE CONCENTRATION OF ALBUMIN 95% CLUCOCORTICOIDS AND 65% ALDOSTERONE LONG HALF LIFE (90 AND 30 MINUTES) METABOLISM AND EXCRETION OF ADRENAL CORTICAL HORMONES INACTIVATION MAINLY IN LIVER MAKES THEM UNRECONIZABLE TO RECEPTORS EXCRETED IN URINE ADRENAL OVERSECRETION MINERALCORTICOIDS: SODIUM RETENTION, POTASSIUM DEPLETION CORTISOL:EXCESS GLUCONEOGENESISEXCESS GLUCOSE DEPOSITED AS FAT (CUSHING’S SYNDROME) ANDROGEN: MASCULINIZATION, PSEUDOHERMAPHODITISM, PRECOCIOUS PSEUDOPUBERTY, NO EFFECT IN ADULT MALES ADRENAL INSUFFICIENY CORTEX: ADDISON’S DISEASE POOR RESPONSE TO STRESS LACK OF PERMISSIVE ACTION POTASSIUM RETENTION HYPOTENSION MEDULLA: CATECHOLAMINES A MODIFIED SYMPATHETIC POST GANGLIONIC NEURON EPINEPHRINE ACTIONS OF EPINEPHRINE MIMICS SYMPATHETIC NS MOBILIZES STORED FAT AND CARBOHYDRATE HEART AND BLOOD VESSELS GENERAL ADAPTATION SYNDROME FLIGHT OR FIGHT EPINEPHRINE CRH-ACTH-CORTISOL RENIN-ANGIOTENSIN-ALDOSTERONE VASOPRESSIN COORDINATED BY HYPOTHALAMUS CAN BE INDUCED PSYCHOSOCIALLY EPINEPHRINE, CORTISOL, AND GROWTH HORMONE ALL INCREASE BLOOD GLUCOSE AND FATTY ACIDS CORTISOL INCREASES BLOOD AA AND DECREASES MUSCLE PROTEIN GH DECREASES BLOOD AA AND INCREASES MUSCLE PROTEIN