01 PHYSIOLOGY

41. Adrenal gland

Questions on the adrenal gland should be relatively straightforward, but you will need a good understanding of
the different endocrine feedback mechanisms that exist. Endocrine-based questions can also easily lead into
clinical issues of under/overactive glands, so for this section we would recommend you familiarise yourself with
hyperaldosteronism (primary and secondary), Addison’s disease, Cushing’s syndrome and phaeochromocytomas.

Describe the anatomical
organisation of the adrenal
gland.
The adrenal or suprarenal glands lie on top of the upper poles of the kidneys
and play a key role in the synthesis of corticosteroids and catecholamines.
The adrenal glands are at the level of the twelfth thoracic vertebra.
Anatomically, the adrenal gland is divided into two distinct areas: an outer
cortex and inner medulla.
Adrenal cortex:
> Site of synthesis of corticosteroid hormones (glucocorticoids and
mineralocorticoids) and androgens.
> Under neuroendocrine control via the hypothalamic–pituitary–adrenal
axis.
> Part of the renin–angiotensin–aldosterone pathway.
> Divided into three functional zones from outside to inside: zona
glomerulosa, zona fasciculata and zona reticularis (an easy way to
remember this is ‘GFR’).
Adrenal medulla:
> Composed of chromaffin cells.
> Main site of synthesis of adrenaline and noradrenaline.
> Hormone secretion occurs in response to stimulation by pre-ganglionic
(cholinergic) nerve fibres from the sympathetic nervous system (via
splanchnic nerves).

What are the main hormones > Zona glomerulosa: mineralocorticoids (aldosterone).
secreted from each of the three > Zona fasciculata: glucocorticoids (cortisol).
zones of the adrenal cortex?
> Zona reticularis: androgens (dehydroepiandrosterone).

Describe the cortisol negative
feedback pathway.
The hypothalamus secretes corticotrophin-releasing hormone (CRH), which
stimulates release of adrenocorticotropic hormone (ACTH) from the anterior
pituitary. ACTH stimulates cortisol secretion from the zona fasciculata of the
adrenal cortex. Cortisol exerts negative feedback on both CRH and ACTH
release.

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Describe the control of
aldosterone secretion.
What are major actions of
cortisol?
What are the main actions of
aldosterone?
Describe how catecholamines
are synthesised.
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ADRENAL GLAND
> Renin–angiotensin–aldosterone (RAA) system: Reduced circulating
volume is detected by the reduction in renal afferent arteriolar pressure
causing renin secretion from the juxtaglomerular cells. Renin cleaves
angiotensinogen to produce angiotensin I, which is then converted to
angiotensin II in the pulmonary vasculature by angiotensin-converting
enzyme (ACE). Angiotensin II promotes aldosterone secretion.
> Fall in plasma sodium concentration: Reduced serum sodium is
detected by the macula densa in the distal convoluted tubule of the
kidney and stimulates the secretion of aldosterone in order to increase
sodium retention.
> Rise in plasma ACTH: Also exerts a direct effect in increasing
aldosterone secretion from the zona glomerulosa.
Cortisol exerts its effects by binding to glucocorticoid receptors and
promoting specific enzyme synthesis. The glucocorticoids works in many
ways to provide resistance to 'stress', having effects on metabolism,
immune function and vascular reactivity.
> Metabolism:
• Increased protein catabolism
• Increased hepatic gluconeogenesis and increased plasma glucose
levels
• Increased lipolysis
> Vascular:
• Cortisol is essential in maintaining vascular reactivity to noradrenaline.
> Immune:
• Suppresses the immune system, impairs wound healing and has anti-
inflammatory effects.
Aldosterone increases the reabsorption of sodium from the distal convoluted
tubules of the kidney, resulting in sodium retention and plasma expansion. It
also increases urinary potassium excretion.
Catecholamines are synthesised in the chromaffin cells of the adrenal
medulla:
L-TYROSINE
↓ Tyrosine hydroxylase
L-DOPA
↓ Dopa decarboxylase
DOPAMINE
↓ Dopamine hydroxylase
NORADRENALINE
↓ Phenylethanolamine N-methyltransferase
ADRENALINE
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