Adrenal Hormone Mineralocorticoids Aldosterone

Transcript

1 Adrenal gland Adrenal Hormone Mineralocorticoids Aldosterone Cortex 80 % Glucocorticoids Cortisol Sex hormones Androgen Medulla 20% Catecholamines E, NE Adrenal cortex hormones Glucocorticoid Mineralocorticoids Sex hormones Adrenal medulla Norepinephrine 20% Epinephrine 80% Adrenal steroids biosynthesis Adrenal-pituitary feedback regulation Anxiety Stress Depression Sleep/ awake Feeding CRH ADH Neurotransmitters ACTH ACTH Cortisol ACTH Stimulate Inhibit DHEA Aldosterone Cortisol 1

2 Organs Major Adipose tissue Lipolytic hormones FFA Liver Glycogen G-6-P Glucose precursors Glucose Actions Lipolysis Redistribution of fat Gluconeogenesis Glucose utilization sensitivity CNS Appetite (chronic) CVS Sympathetic actions CO Blood pressure Erythropoietin Muscle Glucose Amino acids Protein Diabetogenic effects Protein break down GI Gastric acid and pepsin secretion Anti-inflammation phospholipase A2 PGs, TXs, LTs Interleukin Capillary permeability Phagocytosis Anti-allergic action Eosinophils Collagen synthesis: skin, blood vessels Kidney ADH Mineralocorticoid effects Na + retention/ K + excretion Muscle Muscle mass Muscle weakness Immuno-suppressant T-lymphocytes Reproductive H-P-G axis Bone protein matrix/ Osteblast. GI Ca 2+ absorption. Renal Ca 2+ excretion Blood calcium PTH Bone formation Bone resorption Osteoporosis Anti-inflammation PGs, TXs, LTs Interleukin Capillary permeability Phagocytosis Anti-allergic action Immuno-suppressant T-lymphocytes Suppress antibody 2

3 Abnormal glucocorticoids secretion Glucocorticoids excess Cushing s disease Cushing s syndrome (drug) Glucocorticoids deficit Addison s disease (Adrenal insufficiency) Cushing s syndrome Cushing s syndrome High risk infection Delayed wound healing Steroid diabetes Muscle wasting Osteoporosis Hypertension Appeptite Peptic ulcer ( HCl & pepsin) Gonadal disturbances Intra-ocular pressure (glaucoma) Fat deposition of central area: face & body (Truncal obesity) Inhibit skeletal growth ( GH) Steroid psychosis Cushing s disease Addison s disease Moon face Buffalo hump Abdominal striae Appetite Hyperpigmantation or dark tanning of skin both exposed and nonexposed parts of body Fainting / dizziness ( BP) Salt craving Hypoglycemia 3

4 Addison s disease Mineralocorticoids (aldosterone) Increase the reabsorption of Na + form the urine, sweat, saliva and the contents of gastrointestinal tract. Increase the reabsoption of water ( ECF). This is an osmotic effect directly related to increased resorption of sodium. Increase the renal excretion of K + Mineralocorticoids deficit Usually occur with glucocorticoid deficit Salt and water depletion Postural hypotension Dehydration Hypovolemia Hyperkalemia Hypovolemic shock Metabolic acidosis Primary case with increased ACTH Hyperpigmentation Adrenal medulla Adrenal medulla Sympathetic Adrenal gland Ach Sympathetic Ach E, NE norepinephrine 4

5 Adrenal E & NE Marked deviation of homeostasis circulating hormone Adrenal cathecolamines 10%of sympathetic activity Sympathetic NE Fine regulation Neurotransmitter (local hormone) Cathecolamine actions NE and E act via α 1, α 2, β 1, β 2 Adrenergic receptors (Cell-surface receptor) Different receptors Different intracellular mechanisms Intense stimulation circulation Alarm reaction Fear-Flight-fight response Catecholamine actions Increase rate & force of contraction Vasoconstriction Blood pressure Dilatation of bronchiole O 2 supply Catecholamine actions Lipolysis Catecholamine actions Dilation of pupils Glycogenolysis Gluconeogenesis Ketogenesis Glycogenolysis Glucagon Digestion inhibited Hair follicle raised Increase secretion by sweat gland Bladder sphincter relax Blood glucose 5

6 Flight or fight response Pupils dilated Salivation inhibited Increased respiration Bronchial passages dilated Increased heart rate BP Digestion inhibited Secretion of adrenal hormones Increased secretion by sweat glands Hair follicles raised Bladder sphincter relaxed Anatomy and histological of pancreas Islet of Langerhans Exocrine gland: enzymes Parasympathetic fibers A, α % Glucagon B, β 60-80% B cells Sympathetic fibers D, σ 8% Somatostatin D cells A cells F variable Pancreatic polypeptide Islet of langerhans:, Glucagon Chain A: 21 aa Factor affecting insulin secretion Disulfide bridge Chain B: 30 aa Peptide hormone MW 6000 Amino acids GI hormones Diabetogenic H Glucose Vagus N a-adrenergic Somatostatin B cells 6

7 Normal blood glucose 100 mg/dl (3-5 mm) Basal plasma insulin concentration 10 microu/ml signaling a-subunit Meals b-subunit receptor Glucose Glucose Protein transport synthesis Lipid synthesis glycogen synthesis Growth and Gene expression actions deficit Diabetes Millitus Absolute: dependent diabetes mellitus (IDDM)/ Type I 5-10% Protein Amino acid uptake & protein synthesis Amino acid output & amino acid oxidation CHO Glycogen synthesis Glycogenolysis Gluconeogenesis Hepatic glucose production Lipid Triglyceride synthesis Lipolysis Relative: Non insulin dependent diabetes mellitus (NIDDM)/ Type II 90-95% Defect in insulin secretion resistance Receptor Postreceptor Diagnosis Diabetes Millitus A casual plasma glucose level (taken at any time of day) of 200 mg/dl or greater when the symptoms of diabetes are present. A fasting plasma glucose value of 126 mg/dl or greater. Signs and symptoms of diabetes mellitus Hyperglycemia Glucosuria (Osmotic diuresis) Hyperlipidemia Ketonemia Protein wasting Weight loss An OGTT value in the blood of 200 mg/dl or greater measured at the 2-hour interval. 7

8 excess Over dose insulin oma Hypoglycemia Neuroglycopenia Hunger Dizziness Coma Cathecolamine: anxiety, sweating, tachycardia Glucagon 29 amino acids identical to enteroglucagon Glucagon act by binding to its receptor and activated G protein which cause an increase in camp. Glucagon has the effect of increasing blood glucose levels (opposite effect of insulin) Factor affecting glucagon secretion Glucagon actions CHO Glycogen synthesis Glycogenolysis Lipid Lipolysis Gluconeogenesis Hepatic glucose production and glucagon cause the tight control of blood glucose concentration Catecholamines Corticosteroids Growth H 8