Outer layer of adrenal cortex

Hormone synthesis and secretion of:

1) Aldosterone

2) Corticosterone

Does NOT atrophy after hypophysectomy (d/t to stimulation by angiotension II) - Aldosterone secretion stays the same

Middle, biggest layer of adrenal cortex

Hormone synthesis and secretion of:

1) Cortisol

2) Corticosterone

3) Some sex hormones

Inner layer of adrenal cortex

Hormone synthesis and secretion of:

1) Cortisol

2) Corticosterone

3) Most sex hormones

Three kinds of steroid hormones

Which does the adrenal cortex primarily secrete?

C21, C19 and C18 steroids

Adrenal cortex primarily secretes C21 and C19 steroids

Mineralocorticoids - Effects of Na+ and K+ excretion predominate

Glucocorticoids - Effects on glucose and protein metabolism predominate

True

-Adrenocortical cells secrete hormones as soon as they are made

-Store esterified cholesterol

Cholesterol

Aldosterone

Desoxycorticosterone

Cortisol 

Corticosterone

Dehydroepiandrosterone

DHEA

Fatal in utero

Prevents placenta from making progesterone

Causes Spontaneous abortion

DHEA increased resulting in ambiguous genitalia

Increased androgens and decreased glucocorticoids

No sex hormones

Elevated mineralocorticoids

Cortisol deficiency `

Exogenous glucocorticoids

-Repairs glucocorticoid deficit

-Provides negative feedback which inhibits ACTH

Decreased

-CBF level falls, free hormone increases which increases negative feedback

Less ACTH secreted and free hormone drops to normal concentration

Cortisol to cortisone

Not reverse

1. Diabetogenic (increased BG)

2. Insulin resistance (decreased glucose tolerance)

3. Hyperglycermia

4. Permissive for increase gluconeogenesis due to glucagon & catecholamines

5. Permissive for peripheral protein mobilization

6. Increased protein catabolism (muscle, peripheral)

7. Increase gluconeogenesis

8. Increase glycogenesis

9. Increased ketosis

10. Decreased lipogenesis

11. Decreased peripheral glucose utilization

12. Carbohydrate metabolism

1. Gluconeogenesis effect of glucagon

2. Calorigenic effect of glucagon, catecholamines

3. Lipolysis, free fatty acid mobilization by catecholamines

4. Vasoconstriction (pressor effects) due to catecholamines

5. Bronchodilation due to catecholamines

1. Slowing of EEG waves

2. Personality changes

3. Increased sensitivity to olfactory and gustatory stimuli

1. Increased secretion of gastric HCl and Pepsin

2. Increase intestinal absorption of fat into lymph

1. Glucocorticoid deficiency causes inability to excrete a water load

2. Retention of water in excess of Na+ retention

3. Glucocorticoid treatment

Effects of glucocorticoid deficiency on blood cells and lymphatic organs

1. Decreased eosinophils in circulation

2. Decreased basophils

3. Decreased lymphocytes

4. Increased neutrophils

5. Increased platelets

6. Increased RBC

7. Decreased size of thymus, lymph nodes, spleen due to inhibition of mitosis

8. Anti-inflammatory effects at high levels (such as stress or cushings syndrome)

9. Can be dangerous because it allows bacteria to spread

1. Requires increased ACTH and increased glucocorticoids that normally accompany stress

2. Exerts partly permissive action on vascular reactivity to catecholamines

3. Permissive for catacholamine mobilization of free fatty acids as emergency energy supply

4. Can withstand some stress after sympathectomy

5. Tepperman scheme for stress response - Possibly to mobilize amino acids and energy for wound repair

6. Stress increases plasma glucocorticoids to "pharmacologic" levels that in short run are life saving but in long run are harmful and disruptive

Other effects:

1. Decrease GH secretion

2. Induce PNMT

3. Decrease TSH secretion

4. Accelerate surfactant production by lung in fetus

1. Hyperglycemia

2. Increase lipogenesis

3. Peptic ulcers

4. Thin skin and subcutaneous tissues, poorly developed muscles and muscle weakness, poor wound healing

5. Nervous system effects - Increased EEG rhythms, mental aberrations, increased appetite, weight gain, insomnia, euphoria, psychoses

6. Suppressed immune system

7. Increased facial hair and acne

8. Hypertension

1) Fatigue and weakness

2) Weight gain and obesity

3. Changed appearance

4) Amenorrhea or irregularity

5) Bruising

6) Nervousness, depression, irritability

7) Back pain and bone pain

8)Hirsutism

9) Headache

10) Ankle and hand edema

11) Libido in female, impotence in male

12) Paresthesias

13) Lower voice

14) Blurred vision

15) Poor wound healing and leg ulcers

16) Cessation of growth

17) Difficulty Walking

18) General aching and malaise

1) Fatal due to hypotension and hypovolemic shock

2) Inability to cope with even minor noxious stimuli

Adrenal insufficiency - Incomplete loss of adrenal cortex

Addisonian crisis - Minor stress is emergency

Decreased size of heart secondary to chronic hypotension

Adrenocortical atrophy:
1) Autoimmune disease

2) Cancer

3) Tuberculosis

1. Low renin

2. Aldosterone low but glucocorticoids normal

1. Resistance to aldosterone action

2. Marked hyperkalemia

3. Salt wasting

4. Hypotension

5. May develop metabolic acidosis

1. Circadian rhythm

2. Response to stress

3. Glucocorticoid feedback