Hormones of the Adrenal Cortex Glucocorticoids Mineralocorticoids Adrenal Androgens 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Adrenal Gland The adrenal gland is composed of Cortex Medulla 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Adrenal Gland Adrenal cortex Secrete steroid hormones Glucocorticoids Cortisol Corticosterone Mineralocoticoids Aldosterone Sex hormones Adrenal androgens 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Adrenal Gland Disorders of adrenal gland lead to endocrinopathies Hypercorticolism Cushing’s syndrome Adrenal insufficiency Addison’s disease Hyperaldosteronism Conn’s syndrome Hypoaldosteronism Androgen excess Syndrome of congenital adrenal hyperplasia 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Adrenal Gland Glucocorticoids help regulate metabolism Carbohydrate Proteins Fat Mineralocorticoids help regulate N+ & K+ balance ECF volume 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Adrenal Cortex The adult cortex composed of 3 zones Glomerulosa Fasciculata Reticularis 28-May-18 Adrenocortical Hormones

Disorders of Adrenocortical Hormones Secretion 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Disorders Hypercorticolism Cushing’s syndrome Adrenal insufficiency Addison’s disease Hyperaldosteronism Conn’s syndrome Hypoaldosteronism Androgen excess Syndrome of congenital adrenal hyperplasia 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Hypercortolism Cushing’s syndrome Condition resulting from chronic exposure to excess glucocorticoids Cushing syndrome ACTH dependent ACTH independent 28-May-18 Adrenocortical Hormones

ACTH dependent Cushing’s syndrome Classification ACTH dependent Pituitary adenoma (secrete ACTH) Cushing’s disease 28-May-18 Adrenocortical Hormones

ACTH dependent Cushing’s syndrome Non-pituitary neoplasm Ectopic ACTH (lung tumours) Chronic ACTH hypersecretion leads to Hyperplasia of zona fasciculata & reticularis 28-May-18 Adrenocortical Hormones

ACTH dependent Cushing’s syndrome Iatrogenic (ACTH therapy) 28-May-18 Adrenocortical Hormones

ACTH independent Cushing’s syndrome Primary adrenal neoplasia Adenoma or carcinoma Produce excess cortisol Suppress ACTH 28-May-18 Adrenocortical Hormones

ACTH independent Cushing’s syndrome Iatrogenic Chronic glucocorticoid therapy Leads to inhibition ACTH Atrophy of cortex 28-May-18 Adrenocortical Hormones

Effects of Cortisol Excess Affects almost all systems 28-May-18 Adrenocortical Hormones

Effects of Cortisol Excess Excessive physiological effects of glucocorticoids Metabolic effects Anti-inflammatory effects Antigrowth effects Stress adaptation Vascular effects, renal effects GIT effects CNS effects 28-May-18 Adrenocortical Hormones

Effects of Cortisol Excess On connective tissue Inhibition of fibroblasts Loss of collagen and connective tissue Results in Thinning of skin Easy bruising Stria formation Poor wound healing 28-May-18 Adrenocortical Hormones

Effects of Cortisol Excess On bone Inhibit bone formation because  Protein synthesis, collagen  Oesteolysis On Ca++ metabolism Its intestinal absorption, leads to  serum Ca++ concentration Secondary  PTH secretion urinary excretion of Ca++ Thus a negative Ca++ balance 28-May-18 Adrenocortical Hormones

Effects of Cortisol Excess Blood cells RBCs little direct effect Leucocytes  number of polymorphnuclear cells (PMN) in circulation  number of circulating Lymphocytes, monocytes, eosinophils Glucocorticoids decrease migration Inflammatory cells to site of injury 28-May-18 Adrenocortical Hormones

Effects of Cortisol Excess On CVS  CO, peripheral vascular tone Glucocorticoids in excess cause Hypertension Regulation of renin substrate Renal function Mineralocorticoid effects Na+ retention Hypokalaemia 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones 28-May-18 Adrenocortical Hormones

Effects of Excess Androgens  Plasma levels of DHEA and androstenedione Conversion to androgen excess Testosterone Dihydrotestosterone 28-May-18 Adrenocortical Hormones

Effects of Excess Androgens In women Hirsutism, acne Amenorrhoea In men with Cushing’s syndrome Cortisol suppress LH  Testosterone secretion (testes)  Libido, impotence 28-May-18 Adrenocortical Hormones

Hyperaldosteronism (Conn’s Syndrome) Excess production of mineralocorticoids Primary hyperaldosteronism Aldosterone secreting tumours (adenoma) Secondary hyperaldosteronism Renal ischaemia Low intravascular volume CCF, diuretic therapy, Hypoprotenemic states (cirrhosis) 28-May-18 Adrenocortical Hormones

Hyperaldosteronism (Conn’s Syndrome) Manifestation Consequences of excess aldosterone Na+ retention K+ & H+ wasting by kidney Initially Na+ retention leads to ECFV expansion Increased CO & BP Then Sodium escape phenomenon 28-May-18 Adrenocortical Hormones

Hyperaldosteronism (Conn’s Syndrome) End stage Elevated aldosterone promote Continued Na+ exchange for K+, H+ There is K+ depletion and alkalosis 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Hypocorticolism Adrenal insufficiency Addison’s disease Deficient production of Glucocorticoids Mineralocorticoids Causes Primary adrenal insufficiency Autoimmune diseases Malignancies Adrenal haemorrhage Infections – TB Familial glucocorticoid defficiency 28-May-18 Adrenocortical Hormones

Adrenocortical Hormones Hypocorticolism Secondary adrenal insufficiency Anterior pituitary failure Deficient secretion of ACTH by pituitary 28-May-18 Adrenocortical Hormones

Mineralocorticoid deficiency Lack of aldosterone secretion leads to Decreased Na+ reabsoption by kidney Na+, Cl-, H2O lost in urine Fall in ECFV, dehydration Hayponatraemia, hyperkalaemia, mild acidosis Depletion of ECFV Plasma volume falls Haemoconcetration Fall in CO Shock 28-May-18 Adrenocortical Hormones

Glucocorticoid deficiency Lack of cortisol ↓ gluconeogenesis It will be difficult to maintain BG between meals Lack of mobilization of proteins, fats Individual cannot handle stress Mild trauma can cause death Skin pigmentation Lead to excess ACTH, α-MSH 28-May-18 Adrenocortical Hormones