Kelenjar Suprarenal

dr. H. Huldani, MM, M.Imun

 Adrenal Glands
Adrenal glands sit a top the kidneys and have an
inner adrenal medulla and an outer adrenal
cortex.
The hypothalamus uses ACTH-releasing
hormone to control the anterior pituitary’s
secretion of ACTH that stimulates the adrenal
cortex.
The hypothalamus regulates the medulla by
direct nerve impulses.

20-2
Medulla dan Cortex Adrenal
The adrenal medulla secretes epinephrine and norepinephrine,
which bring about responses we associate with emergency
situations.

On a long-term basis, the adrenal cortex produces

glucocorticoids similar to cortisone and mineralocorticoids to
regulate salt and water balance.

The adrenal cortex also secretes both male and female sex
hormones in both sexes.

20-4
 Lapisan Adrenal
• Zona glomerulosa → memproduksi hormon
mineralokortikoid (aldosteron (90 %),
desoksikortikosteron, kortikosteron, 9α-
Fluorokortisol, kortisol, dan kortison)
• Zona fasikulata → memproduksi hormon
glukokortikoid (bersama dengan zona retikularis) :
Kortisol 95 %, kortikosteron, kortison, prednison,
metilprednison, deksametason
• Zona retikularis → memproduksi hormon androgen
Adrenal glands

20-7
Regulasi hormon korteks adrenal
Regulasi hormon medulla adrenal
 Glucocorticoids
Cortisol promotes breakdown of muscle proteins to
amino acids; the liver then breaks the amino acids
into glucose.

Cortisol also promotes metabolism of fatty acids rather

than carbohydrates, which spares glucose.

Both actions raise the blood glucose level.

High levels of blood glucocorticoids can suppress
immune system function.
20-11
 Mineralocorticoids
Aldosterone causes the kidneys to reabsorb sodium
ions (Na+) and excrete potassium ions (K+).
When blood sodium levels and blood pressure are
low, the kidneys secrete renin; the effect of the
renin-angiotensin-aldosterone system is to raise
blood pressure.
The hormone atrial natriuretic hormone produced
by the heart inhibits the secretion of aldosterone,
thus reducing blood pressure.

20-12
KELENJAR ADRENAL/SUPRARENAL
Hormon Struktur Sasaran Aksi
Korteks Adrenal
Kortisol Steroid ~ kadar gula darah,
(Glukokortikoid) adaptasi terhadap stress
Aldosteron Steroid Tubulus ginjal reabsorpsi Na+ dan sekresi
(Mineralokortikoid) K+ dan H+
Androgen (DHEA) Steroid ~ pertumbuhan masa pubertas &
dorongan seks (♀)
Medulla Adrenal
Epinefrin, Asam amino Otot, jantung, inisiasi respons terhadap stress
norepinefrin hati, & persiapan aktivitas fisik,
pembuluh mengatur tekanan darah
darah,
jaringan
lemak
 Malfunction of the Adrenal Cortex
Addison disease (hipoadrenalisme) develops when
the adrenal cortex hyposecetes hormones (atrofi
primer caused autoimunitas, tbc, cancer)
A bronzing of the skin follows low levels of cortisol,
and mild infection can lead to death; aldosterone
is also hyposecreted, and dehydration can result.
Cushing syndrome (Hiperadrenalisme) develops
when the adrenal cortex hypersecretes cortisol.
The trunk and face become round; too much
aldosterone results in fluid retention.

20-14
Addison disease

20-15
Addisone Disease
 Gejala Addison Disease
• Defisiensi mineralokortikoid : reabsorsi natrium di ginjal
menurun → Natrium, klorida dan air ke urin → volume
cairan ekstraseluler berkurang → hiponatremia,
hiperkalemia dan asidosis ringan, volume plasma
menurun, konsentrasi sel darah merah meningkat,
curah jantung menurun → renjatan → kematian
• Defisiensi glukokortikoid : kortisol turun→ tdk dpt
mempertahankan glukosa darah, mobilisasi protein dan
lemak di jaringan menurun
• Pigmentasi melanin pada mukosa membran dan kulit
 Adrenocortical insufficiency
• primary causes, ie. Addison’s disease
– autoimmune disease, tumors, infection,
hemorrhage, metabolic failure,

• secondary causes
–hypopituitarism, suppression
exogenous steroids
 Hyperadrenocorticism

• cushing’s sydndrome
• 3rd - 6th decade, 4 to1 females
• causes
– pharmocologic
– pituitary adenoma 75-90%
– adrenal adenoma, carcinoma
– ectopic ACTH
• treatment based on cause
Cushing syndrome

20-21
 Gejala Sindrom Cushing
• Mobilisasi lemak dari bagian bawah tubuh,
penimbunan lemak di thorax dan abdomen
• Wajah membengkak dan membulat (moon
face)
• Jerawat dan hirsutisme (pertumbuhan bulu
wajah yang berlebihan) karena androgen.
Selamat Belajar