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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


Adrenal medulla chromate salt stain

Brownish cytoplasm granules- when fixed by chromate salt containing fixative

Also called chromaffin cell

Adrenal medulla chromate salt stain


Hormones of adrenal medulla
Hormones of adrenal medulla containing fixative

Adrenaline

Catecholamines

Noradrenaline

Dopamine

Opiate peptides

Peptides

Adrenomedullin

Arginine vasopressin

Vasoactive intestinal peptide


Catecholamine ca
Catecholamine (CA) containing fixative


Synthesis of catecholamine
Synthesis of catecholamine containing fixative


Synthesis of catecholamine1
Synthesis of catecholamine containing fixative

  • PNMT

  • Regulated by glucocorticoids.


Secretion of catecholamine containing fixative


Regulation of catecholamine secretion containing fixative

  • 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 containing fixativeadrenal 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 containing fixative

  • 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? containing fixative

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 containing fixativeDisorders of the adrenal medulla

Phaeochromocytoma: a tumor causes

adrenal medullary hormones over-secretion


Phaeochromocytoma
Phaeochromocytoma containing fixative

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 containing fixative

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

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

(3) Operation


Familial phaeochromocytoma
Familial Phaeochromocytoma containing fixative



Clinical uses of adrenaline
Clinical uses containing fixativeof adrenaline

1. Cardiac arrest

2. Allergic shock: first choice

3. Bronchial asthma

4.Prolongation of local anesthetic duration

5. Topical hemorrhage


AD: first choice for allergic shock containing fixative

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 uses containing fixativeof NA

  • Shock and hypotension

    2. Upper digestive tract hemorrhage


Endocrine hypertension
Endocrine hypertension containing fixative

Belongs to secondary hypertension:

Conn’s syndrome

Cushing’s syndrome

Phaeochromocytoma


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