Understanding Adrenal Cortex Hormones: Functions and Disorders

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

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

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

4. 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 Adrenocortical Hormones

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

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

7. Disorders of Adrenocortical Hormones Secretion Adrenocortical Hormones

8. Disorders • Hypercorticolism • Cushing’s syndrome • Adrenal insufficiency • Addison’s disease • Hyperaldosteronism • Conn’s syndrome • Hypoaldosteronism • Androgen excess • Syndrome of congenital adrenal hyperplasia Adrenocortical Hormones

9. Hypercortolism • Cushing’s syndrome • Condition resulting from chronic exposure to excess glucocorticoids • Cushing syndrome • ACTH dependent • ACTH independent Adrenocortical Hormones

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

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

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

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

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

21. Adrenocortical Hormones

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

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

27. 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 Adrenocortical Hormones

28. Hypocorticolism • Secondary adrenal insufficiency • Anterior pituitary failure • Deficient secretion of ACTH by pituitary 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 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 • Lack of cortisol • Lead to excess ACTH, α-MSH Adrenocortical Hormones