PHYSIOLOGY OF

ADRENAL GLANDS

HENDRA KURNIAWAN

DIVISI PENYAKIT TROPIK DAN INFEKSI

DEPT. KEP. MEDIKAL BEDAH
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH JEMBER
 Adrenal Glands
Adrenal Cortex Adrenal Medulla
The outer layers The inner
80% of the portion
adrenal glands 20% of the
Secrete steroid adrenal glands
hormones Secrete
catecholamine
They have different on
1. Embryologically deriving
2. Chemical categories, whose functions, mechanism of action
and regulation
 Adrenal Cortex
Zona Glomerulosa
Mineralocorticoid, mainly aldosterone
Influence mineral balance (Na+ and K+ balance)
Blood Pressure homeostasis

Zona Fasciculata
Glucocorticoid, primarily cortisol
Play a major role in glucose metabolism
Sex hormone

Zona Reticularis
Sex hormone, dehydroepiandrosteron (DHEA)
DHEA is the most important males sex hormone
Glucorticoid
 Adrenocortical Hormone
Being lipophilic
In the blood extensively bound to plasma protein
60% of aldosteron in the blood bounds to
albumin
98% of cortisol in the blood bounds to
plasma protein called corticosteroid
binding globulin (transkortin)
98% of DHEA bounds to albumin
 Mineralocorticoid Hormone
Two major effects are on Na+ and K+ balance
and blood pressure homeostasis

Distal tubules

Retention of
Aldosteron Retention H2O
Na+
Elimination K+
Collecting
tubules Long term
regulation of
blood pressure
 Aldosteron Secretion
Increased by
1. Activation of renin-angiotensin-aldosteron
system related to a reduction in Na+ and a
fall in blood pressure.
Angiotensin promotes growth of the zona glomerulosa

2. Direct stimulation of the adrenal cortex by a

rise in plasma K+ concentration

The regulation of aldosteron secretion is largely independent

of anterior pituitary control
 Glucocorticoid Hormone
Cortisol is the primary product
Have an important role in
Carbohydrate, protein, and fat metabolism
Executes significant permissive actions for
other hormonal activities
Helps people resist stress
 Metabolic Effects
Cortisol

Stimulates hepatic Inhibits glucose Stimulates protein Facilitates lipolysis

Gluconeogenesis uptake and use by degradation in
many tissue, but many tissue
Releasing free
not the brain
fatty acid
Increases amino-
acid concentration
As an
alternative
Used in
metabolic fuel
Gluconeogenesis

Increasing blood glucose concentration

 Permissive Actions
A given hormones effect are influenced not
only by the concentration of the hormone itself
but also by the concentration of other hormone
that interact whit it
Example
Cortisol must be present in adequate amount to
permit the catecholamines to induce
vasoconstriction
Lacking cortisol circulatory shock
 Role in Adaptation to Stress

Stressor
Physical Chemical Psychological or Social
emotional

Increasing Cortisol Secretion

Increasing blood Increasing Increasing fatty

glucose amino acids acids
 Anti-inflammatory and
Immunosuppressive Effects
Glucocorticoids suppress almost every aspect of
the inflammatory response
Destroy lymphocytes
Reduce antibody production

Inhibit effect of the white blood cells

Glucocorticoid is an effective drugs in treating

condition in which the inflammatory response
itself has become destructive
 Use cortisol carefully !
1. They suppress normal inflammatory and immune
response. It has limited ability to resist infection
2. In prolonged exposure: it will develop gastric
ulcer, high blood pressure, atherosclerosis, and
menstrual irregularity
3. High levels of exogenous glucocorticoid will
suppress the hypothalamus-pituitary axis. It can
lead to irreversible atrophy of the cortisol-
secreting cells
Control of
Cortisol
Secretion
 Influence of Diurnal Rhythm
Highest levels occurs in the morning
Lowest levels occurs in the night
Its related primarily to the sleep-wake cycle

It is reversed in people who works at night and sleeps

during day
 Sex Hormone
The adrenal cortex produces both androgen (male) sex
hormone and esterogen (female) sex hormone.
But they are not sufficiently abundant or powerful to induce
masculinizing or feminizing effects
The main site of production for the sex hormone is the
gonads
Testes for androgens
Ovaries for esterogens
The only adrenal sex hormone that has any biologic
importance is the androgen dehydroepiandrosteron
(DHEA)
Adrenal Androgen in male
It is overpowered by testicular testosterone
Induce the male pattern of hair growth
Cause the voice to deepen

Develops sex drive at puberty

Adrenal Androgen in female

Growth of pubic and axillary hair
Enhancement pubertal growth
Development and maintenance sex drive
Hypersecretion of the Adrenal Cortex

Three main pattern of symptoms

depending on which hormone type is in
excess
Aldosteron hypersecretion
Cortisol hypersecretion
Adrenal-androgen hypersecretion
 Aldosteron Hypersecretion
Caused by
1. A hypersecreting adrenal tumor made up of
aldosterone-secreting cells
(primary hyperaldosteronism or conns syndrome)
2. Inappropriately high activity of renin -
angiotensin system
(secondary hyperaldosteronism)
Atherosclerotic a chronic reduction in arterial
blood flow to kidney RAA system activated
excessively
The symptoms of both primary and
secondary hyperaldosteronism

Excessive Na retention (hypernatremia)

Fluidretention
High blood pressure (hypertension)

K depletion (hypokalemia)
 Cortisol Hypersecretion
Known as Cushings syndrome, caused by
1. Overstimulation of the adrenal cortex by
excessive amounts of CRH and/or ACTH
2. Adrenal tumor uncontrollably secrete
cortisol independent of ACTH
3. ACTH-secreting tumors located in places
other than the pituitary commonly in the
lung
 Characteristic of
Cushings syndrome
Related to exaggerated effects of glucocorticoid
Excessive gluconeogenesis
Hyperglicemia and glucosuria mimic diabetes
mellitus adrenal diabetes
Extra glucose is deposited as body fat, typically
located in:
Abdomen
face moon face

above shoulder blades buffalo hump

 Characteristic of
Cushings syndrome
Mobilization of amino acids from body protein
Loss of muscle protein weakness and fatigue
The weakening of blood vessel subcutaneous
bleeding
Wound heal poorly
Losing the collagen framework of bone fractures
my result from little or no apparent injury
The skin becomes thin, forming irregular,
reddish-purple linear streaks overstretched by
the excessive underlying fat deposit
 Adrenal Androgen Hypersecretion

Masculinizing condition is more common

than feminizing condition
Effects on the genitalia and associated
sexual characteristics
The symptoms depend on the sex of
individual and the age when the
hyperactivity first begin
 Effects on Females
In adult females
Tends to develop a male pattern of body hair
(hirsutism)
Deepening of the voice

More muscular arms and legs

The breast become smaller

Menstruation may cease a result of androgen

suppression of the womans hypothalamus-pituitary-
ovarian pathway
In newborn females
Female pseudoher-
maphroditsm
 Effects on Males
In prepubertal males
Prematurely develop male secondary sexual characteristic
Deep voice, beard, enlarged penis and sex drive
It is referred to as precocious pseudopuberty
The androgen secretion from the cortex adrenal
There is no sperm production or any other gonadal activity
because the testes are still in their nonfunctional prepubertal
state
In adult males
Has no apparent effect, because male sex characteristic
already exist
The androgenital
syndrome is most
commonly caused
by an inherited
enzymatic defect in
the cortisol
steroidogenic
pathway
 Adrenocortical Insufficiency
Primary adrenocortical insufficiency (Addisons
disease)
Caused by autoimmune destruction of the cortex
All layers of adrenal cortex are under secretion
Both aldosterone and cortisol are deficient
Secondary adrenocortical insufficiency
Because of pituitary or hypothalamic abnormality
insufficient ACTH secretion
Only cortisol is deficient
 Aldosteron deficiency
K retention (hyperkalemia) and Na depletion
(hypernatremia)
The former disturbs cardiac rhythm
The latter reduces ECF volume hypotension

Cortisol deficiency
Poor response to stress
Hypoglycemia

Lack of permissive action

 Adrenal Medulla
A modified part of the sympathetic nervous
system
Do not have axonal fibers that terminate on
effector organ
Release their chemical transmitter directly into the
circulation
The chemical messenger : epinephrine and
norepinephrine
They are same but epinephrine has a methyl group
Adrenomedullary Catecholamines
Synthesized almost entirely within the cytosol of
the adrenomedullary secretory cells
Stored in chromaffin granules (epinephrine and
norepinephrine)
Secreted into blood by exocytosis
80% epinephrine and 20% norepinephrine
Norpeinephrine effects are predominantly mediated
directly by sympathetic nervous system
Epinephrine effects are brought exclusively by the
adrenal medulla
Adrenergic
receptor types
 Effect of the Sympathetic and
Epinephrine
Cardiovascular
Increase rate and strength of cardiac contraction
Increasing cardiac output
Raise arterial blood pressure
Play an important role in maintenance of arterial blood pressure
Meanwhile, vasodilatation of coronary and skeletal muscle
blood vessels induced by epinephrine
Resporatory
epinephrine (not norepinephrine) dilates respiratory airways
Epinephrine Reduces digestive activity and inhibits
bladder emptying
Metabolic effects of epinephrine
Increase the blood glucose level
Stimulates gluconeogenesis and glycogenolysis in
liver
Stimulates glycogenolysis in skeletal muscle,
indirectly help raise blood glucose
Breakdown muscle glycogen lactic acid into the blood
liver remove lactic acid from the blood and converts it
into glucose
Increase the blood fatty-acid level by promoting
lipolysis
Both of them (blood glucose & fatty-acid) provide
additional fuel for muscle and brain
 Other effects of epinephrine
Effect to the CNS
Promotes a state of arousal and increase CNS
alertness quick thinking
With norepineohrine cause sweating
generated by increased muscular activity
Acts on smooth muscle of the eyes dilate the
pupil and flatten the lens
more encompassing vision
 Action of a stressor on the body

Stressor
Specific response
Body
Non-spesific response
General Adaptation Syndrome

Fight or flight
= sympathetic & epinephrine effects
The multifaceted
stress response is
coordinated by
the hypothalamus
Thank for your
attention