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The Adrenal Glands Part Ⅰ The Adrenal medulla. Ziying WANG Institute of Pharmacology School of Medicine, Shandong University [email protected] Part 1 Introduction. Adrenal Glands. Blood supply. Nerve supply. AD. Embryology of the adrenal gland. Part 2 Adrenal medulla.

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the adrenal glands part the adrenal medulla

The Adrenal Glands PartⅠThe Adrenal medulla

Ziying WANG

Institute of Pharmacology

School of Medicine,

Shandong University

[email protected]

part 2 adrenal medulla

Part 2 Adrenal medulla

At the interface between the neural and endocrine system

case mrs smith a 45 year old woman
Case: Mrs. Smith, a 45-year-old woman
  • Worried for panic attacks
    • Sweating
    • Palpitation
    • Sudden episodes of rapid heart beating
    • Frightened
  • Examination
    • Pale
    • P: 100/min
    • BP: 155/105 to 260-165 mmHg
  • Investigation
    • Serum sodium: 141mmol/L (→)
    • Serum potassium : 3.2mmol/L (↓)
    • Plasma noradrenaline: 12nmol/L (↑ ↑)
    • Plasma adrenaline: 6.7nmol/L (↑ ↑ ↑ ↑)
adrenal medulla
Composed of polygonal cells arranged in cords or cluster

Numerous wide diameter capillaries

Sympathetic ganglion

Adrenal medulla
hormones of adrenal medulla
Hormones of adrenal medulla

Adrenaline

Catecholamines

Noradrenaline

Dopamine

Opiate peptides

Peptides

Adrenomedullin

Arginine vasopressin

Vasoactive intestinal peptide

synthesis of catecholamine1
Synthesis of catecholamine
  • PNMT
  • Regulated by glucocorticoids.
slide16

Regulation of catecholamine secretion

  • The activity of the adrenal medulla is regulated by the activity of the sympathetic nerve.
transport and metabolism of adrenal medullary hormones
Transport and metabolism of adrenal medullary hormones

(1) No specific binding proteins

(2) Onset rapid and short-lived

(3) Metabolized by COMT and MAO

(4) End product: VMA

actions of adrenal medullary hormones
Actions of adrenal medullary hormones
  • Fight and flight neuroendocrine response
  • Emergency reaction hypothesis:

W. B. Cannon, 1928

  • Through activating adrenoceptors
case what is the cause
Case: What is the cause?

Over-secretion of the CA

  • Palpitation
  • Sudden episodes of rapid heart beating
  • Frightened
  • Pale
  • P: 100/min
  • BP:155/105 to 260-165 mmHg
  • Plasma noradrenaline: 12nmol/L (↑ ↑)
  • Plasma adrenaline: 6.7nmol/L (↑ ↑ ↑ ↑)
part 3 disorders of the adrenal medulla

Part 3 Disorders of the adrenal medulla

Phaeochromocytoma: a tumor causes

adrenal medullary hormones over-secretion

phaeochromocytoma
Phaeochromocytoma

Symptoms: with emergency reaction frequently

Diagnosis

(1) CTand MIBG: localization

(2) Symptoms: HBP, HG, high BMR

(3) VMA, AD and NA in urine

Treatment

(1) Operation

(2) Adrenoceptor antagonists

  • α-adrenoreceptor blockers
  • β-adrenoreceptor blockers
case treatment
Case: treatment

(1) Drug treatment:α-blockers→β- blockers

(2) To find the source: CT and MIBG scan

(3) Operation

clinical uses of adrenaline
Clinical usesof adrenaline

1. Cardiac arrest

2. Allergic shock: first choice

3. Bronchial asthma

4.Prolongation of local anesthetic duration

5. Topical hemorrhage

slide28

AD: first choice for allergic shock

Ag-Ab

Allergized cells

AD

x

x

↑HA, SRS, PGs, BK

x

bronchial mucosa vessel dilation

x

Bronchial SM contraction

mucosal edema

dyspnea

Vessel dilation

Intrathoracic pressure↑

DBP↓

↓returned blood volume

x

↓SBP

clinical uses of na
Clinical usesof NA
  • Shock and hypotension

2. Upper digestive tract hemorrhage

endocrine hypertension
Endocrine hypertension

Belongs to secondary hypertension:

Conn’s syndrome

Cushing’s syndrome

Phaeochromocytoma

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