Adrenal Cortex

Has 3 distinct layers or zones, from outside towards middle:

• Zona Glomerulosa
– Zona glomerulosa cells (outer 10%)
synthesize mineralocorticoids
(aldosterone) critical for sodium
retention.
• Zona Fasiculata
Zona fasciculata cells (middle 75%) synthesize
glucocorticoids, such as cortisol, and corticocortisone.
The fasciculata also generate androgen precursors such
as dehydroepiandrosterone (DHEA).
* glucocorticoids (Cortisol) Secreted in response to stress
Stimulate gluconeogenesis &hyperglycemia
(glycogenolysis,) Causes protein catabolism(proteiolysis)

• Zona Reticularis
» Zona reticularis cells (inner 10%) sulfate DHEA to
DHEAS, which is the main adrenal androgen.
 Control of A Cortex H
• ACTH act mainly in the two inner zona.
• Aldosterone mainly controlled by Renin-
angeotensin system in response to low
blood pressure, low blood volume and low
Serum Na.
• Aldosterone secretion is regulated by the
reninangiotensin system (RAS), which functions to
maintain mainly sodium balance. Perceived
volume depletion, low filtered salt, and
sympathetic nerve stimulation is sensed as
hypoperfusion by secreted and stimulates renin
production. Renin is a proteolytic enzyme by renal
cells in the juxtaglomerular apparatus. Renin
initiates a sequence of cleavage steps of
angiotensinogen to form Ang I. Angiotensin-
converting enzyme (ACE)influencing converts
Ang I to Ang II. Ang II acts as a powerful
vasoconstrictor to raise blood pressure and
stimulate aldosterone release.
• Aldosterone acts on the kidney to increase blood
pressure through volume expansion by increasing
sodium reabsorption—hence, water retention.
Aldosterone also stimulates hydrogen and
potassium excretion.
 Diseases of the Adrenal Cortex
– even though there are 3 different classes of hormones, most diseases affect primarily
the glucocorticoids
– Hypersecretion
– Commonest problem = involves glucocorticoids; but some diseases may
have a combination of components
– Of glucocorticoids = Cushing disease
– Commonest etiology = pituitary adenoma secreting ACTH
– Other etiology:
– ectopic ACTH secreting tumor (oat cell lung cancer, etc)
– Primary Adrenal adenoma
– Of mineralcorticoids = hyperaldosteronism
– Commonest etiol = adrenal adenoma

– Of sex steroids = feminization or virilization

– Clinical picture depends on sex
– Commonest etiol = adenoma & associated with Cushing disease
Etiology
– Pituitary adenoma
– Adrenal adenoma
– Ectopic
paraneoplastic
syndrome
 Test for Cushing Disease
• Cortisol have diurnal resim.
• Do Serum Cortisol & urine Cortisol.
• Dexamethazone suppression test:
Steroid suppress ACRH . In Cushing disease,
primarily & ectopic no response.
– Hyposecretion
– Usually affects both glucocorticoids & mineralocorticoids
• Addison Disease = primary adrenal insufficiency
• Commonest etiol = autoimmune destruction of adrenal cortex or infection
eg: TB
• Get increased levels of ACTH
• In secondary hypocortisolism get low levels of ACTH
 Adrenal Medulla
• Works in conjunction with sympathetic nervous system
• Involved in the “stress response”
• Makes catecholamines
• Key ones are norepinephrine (20%) & epinephrine (80%)
• Epinephrine is 10 times more potent in producing direct metabolic
effects.
• Synthesis from tyrosine
• Diseases of Adrenal Medulla
– Pheochromocytoma
• Benign tumor of adrenal medulla
• Cells of medulla called pheochromocytes
• Get hypertension
Lab finding:
1. Blood very high epinephrine .
2. Urine high epinephrine metabolites eg: VMA.