1. Hormones of the Adrenal Cortex
Glucocorticoids
Mineralocorticoids
Adrenal Androgens
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Adrenocortical Hormones

2. Adrenocortical Hormones
Adrenal Gland
The adrenal gland is composed of
Cortex
Medulla
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Adrenocortical Hormones

3. Adrenocortical Hormones
Adrenal Gland
Adrenal cortex
Secrete steroid hormones
Glucocorticoids
Cortisol
Corticosterone
Mineralocoticoids
Aldosterone
Sex hormones
Adrenal androgens
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Adrenocortical Hormones

4. 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

5. Adrenocortical Hormones
Adrenal Gland
Glucocorticoids help regulate metabolism
Carbohydrate
Proteins
Fat
Mineralocorticoids help regulate
N+ & K+ balance
ECF volume
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Adrenocortical Hormones

6. Adrenocortical Hormones
Adrenal Cortex
The adult cortex composed of 3 zones
Glomerulosa
Fasciculata
Reticularis
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Adrenocortical Hormones

7. Disorders of Adrenocortical Hormones Secretion
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Adrenocortical Hormones

8. 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

9. 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

10. ACTH dependent Cushing’s syndrome
Classification
ACTH dependent
Pituitary adenoma (secrete ACTH)
Cushing’s disease
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Adrenocortical Hormones

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

12. ACTH dependent Cushing’s syndrome
Iatrogenic (ACTH therapy)
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Adrenocortical Hormones

13. ACTH independent Cushing’s syndrome
Primary adrenal neoplasia
Adenoma or carcinoma
Produce excess cortisol
Suppress ACTH
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Adrenocortical Hormones

14. ACTH independent Cushing’s syndrome
Iatrogenic
Chronic glucocorticoid therapy
Leads to inhibition
ACTH
Atrophy of cortex
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Adrenocortical Hormones

15. Effects of Cortisol Excess
Affects almost all systems
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Adrenocortical Hormones

16. 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
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Adrenocortical Hormones

17. 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
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Adrenocortical Hormones

18. 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

19. 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
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Adrenocortical Hormones

20. 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
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Adrenocortical Hormones

21. Adrenocortical Hormones
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Adrenocortical Hormones

22. Effects of Excess Androgens
 Plasma levels of DHEA and androstenedione
Conversion to androgen excess
Testosterone
Dihydrotestosterone
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Adrenocortical Hormones

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

24. 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

25. 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

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

27. 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
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Adrenocortical Hormones

28. Adrenocortical Hormones
Hypocorticolism
Secondary adrenal insufficiency
Anterior pituitary failure
Deficient secretion of ACTH by pituitary
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Adrenocortical Hormones

29. 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
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Adrenocortical Hormones

30. 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
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Adrenocortical Hormones