The adrenal glands part the adrenal medulla
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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 Ⅰ The 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 1 introduction

Part 1 Introduction


The adrenal glands part the adrenal medulla

Adrenal Glands


Blood supply

Blood supply


Nerve supply

Nerve supply

AD


Embryology of the adrenal gland

Embryology of the adrenal gland


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

Adrenaline

Catecholamines

Noradrenaline

Dopamine

Opiate peptides

Peptides

Adrenomedullin

Arginine vasopressin

Vasoactive intestinal peptide


Catecholamine ca

Catecholamine (CA)


Synthesis of catecholamine

Synthesis of catecholamine


Synthesis of catecholamine1

Synthesis of catecholamine

  • PNMT

  • Regulated by glucocorticoids.


The adrenal glands part the adrenal medulla

Secretion of catecholamine


The adrenal glands part the adrenal medulla

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


Familial phaeochromocytoma

Familial Phaeochromocytoma


Part 3 pharmacological uses of adrenal medullary hormones

Part 3 Pharmacological uses of adrenal medullary hormones


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


The adrenal glands part the adrenal medulla

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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