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4 - Adrenal Booklet
4 - Adrenal Booklet
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
st
At end of 1 year 1ry degenerates and secondary persists
th
At end of 4 year 2ry proliferates into 3 zones.
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:
L.M 1. Arranged in rounded groups or short
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.
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
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 :-