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Adrenal Disease

Adrenal Disease. Jade Woolley jlw1g10@soton.ac.uk. Anatomy. More anatomy…. Easy anatomy. Last bit of anatomy…. Adrenal Structure. Cortex – secretes steroid hormones Medulla – secretes catecholamines. The Medulla. Contains chromaffin cells

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Adrenal Disease

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  1. AdrenalDisease Jade Woolley jlw1g10@soton.ac.uk

  2. Anatomy

  3. More anatomy…

  4. Easy anatomy

  5. Last bit of anatomy…

  6. Adrenal Structure Cortex– secretes steroid hormones Medulla– secretes catecholamines

  7. The Medulla • Contains chromaffincells • Secrete adrenaline(80%) and noradrenaline(20%) • Chromaffin cells secrete NA/A in response to stimulation by sympathetic nerve fibres • From thoracic segments • Pass through coeliac ganglion

  8. Sympathetic Innervation

  9. Medulla Innervation Summary • Adrenal medulla receives sympathetic innervation • Pre-ganglionic sympathetic fibres release ACh onto chromaffincells • Chromaffin cells release NA/A into circulation

  10. The Cortex Produces steroid hormones

  11. Cortical Hormone Synthesis Cholesterol Progesterone 17α hydroxylase Glucocorticoids (Cortisol) Mineralocorticoids (Aldosterone) Zonaglomerulosa Zonafasciculata

  12. Zonaglomerulosa - Aldosterone • Aldosterone released from z. glomerulosain response to Angiotensin II • Via the renin-angiotensin system • Effects: • It increases renal Na+ and H20 retention • Which increases blood volume and blood pressure

  13. Hyperaldosteronism: • Conn’s syndrome – adrenal tumour secreting aldosterone • Hypertension • Hypernatraemia • Hypokalaemia

  14. Hyperaldosteronism

  15. Aldosterone • Actions of aldosterone on principle cells in late DCT/early collecting duct: • Increased expression of K+ and Na+channels in luminal membrane • Increased activity of Na+/K+pump on basolateral membrane

  16. Zonafasciulata - Cortisol • Cortisol released from z. fasciulatain response to ACTH • Via the hypothalamo-pituitary-adrenal axis • Effects: • Cortisol is a catabolic stress hormone • Anti-insulin – increases plasma glucose • Increases muscle protein degradation • Increases lipolysis and fat mobilisation • Anti-inflammatory and immunosuppressant

  17. Hypercorticism – Cushing’s Syndrome: 1° - adrenal tumoursecreting cortisol 2° - pituitary tumoursecreting ACTH (Cushing’s Disease) - ectopic tumoursecreting ACTH Iatrogenic – corticosteroids

  18. Cushing’s Syndrome effects

  19. Adrenal Medulla - Catecholamines • NA/A released from adrenal medulla • In response to sympathetic stimulation • Effects: • Sympathetic fight or flight response • Tachycardia, hypertension, tremor, sweating • High plasma glucose • Catecholamines cause lipolysis, gluconeogenesis & glycogenolysis • Occurs with pheochromocytoma

  20. Adrenal Insufficiency • Rare, 90% autoimmune • Adrenal cortex destruction • Addisonian crisis Low cortisol = high ACTH (via  –ive feedback) ACTH precursor causes pigmentation

  21. Summary

  22. Supplemental – Stress Response

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