Adrenal gland

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Adrenal Gland

Endocrine system

Adrenal gland

Latin Glandula suprarenalis

 Gray's subject #277 1278

System Endocrine system

Artery Superior, middle and inferior suprarenal arteries

Vein Suprarenal veins

Nerve Celiac and renal plexus

Lymph Lumbar glands

Precursor Mesoderm and neural crest

MeSH Adrenal+Glands

Dorlands/Elsevier Adrenal gland

In mammals, the adrenal glands (also known as suprarenal glands) are endocrine glands that

sit at the top of the kidneys; in humans, the right adrenal gland is triangular shaped, while the left
adrenal gland is semilunar shaped.[1] They are chiefly responsible for releasing hormones in
response to stress through the synthesis of corticosteroids such
as cortisol and catecholamines such as epinephrine (adrenaline) andnorepinephrine. These
endocrine glands also produce androgens in their innermost cortical layer. The adrenal glands
affect kidney function through the secretion of aldosterone, and recent data (1998) suggest that
adrenocortical cells under pathological as well as under physiological conditions
show neuroendocrine properties; within the normal adrenal, this neuroendocrine differentiation
seems to be restricted to cells of the zona glomerulosa and might be important for
an autocrine regulation of adrenocortical function.[2]

Contents

 [hide] 

 1 Anatomy and physiology

o 1.1 Cortex

o 1.2 Medulla

o 1.3 Blood supply

 2 Diseases involving the adrenal glands

 3 Terminology
 4 See also

 5 References

 6 External links

Anatomy and physiology[edit]

The adrenal glands are located in the retroperitoneum superior to the kidneys, they are

quadrilaterial in shape and are situated bilaterally. The combined weight of the adrenal glands in
an adult human ranges from 7 to 10 grams.[3] They are surrounded by an adipose
capsule and renal fascia.

Each adrenal gland has two distinct structures, the outer adrenal cortex and the inner medulla,
both of which produce hormones. The cortex mainly
produces cortisol, aldosterone and androgens, while the medulla chiefly
produces epinephrine and norepinephrine. In contrast to the direct innervation of the medulla, the
cortex is regulated by neuroendocrine hormones secreted from the pituitary gland which are under
the control of thehypothalamus, as well as by the renin-angiotensin system.

Cortex[edit]

Main article:  Adrenal cortex

The adrenal cortex is devoted to production of corticosteroid and androgen hormones. Specific

cortical cells produce particular hormones includingaldosterone, cortisol, and androgens such
as androstenedione. Under normal unstressed conditions, the human adrenal glands produce the
equivalent of 35–40 mg of cortisone acetate per day.[4]

The adrenal cortex comprises three zones, or layers. This anatomic zonation can be appreciated
at the microscopic level, where each zone can be recognized and distinguished from one another
based on structural and anatomic characteristics.[5] The adrenal cortex exhibits functional
zonationas well: by virtue of the characteristic enzymes present in each zone, the zones produce
and secrete distinct hormones.[5]

Zona glomerulosa (outer)

The outermost layer, the zona glomerulosa is the main site for production of aldosterone,
a mineralocorticoid, by the action of the enzymealdosterone synthase (also known
as CYP11B2).[6][7] Aldosterone is largely responsible for the long-term regulation of blood
pressure.[8]Aldosterone's effects are on the distal convoluted tubule and collecting duct of
the kidney where it causes increased reabsorption of sodium and increased excretion of
both potassium (by principal cells) and hydrogen ions (by intercalated cells of the
collecting duct).[8] Sodium retention is also a response of the distal colon, and sweat
glands to aldosterone receptor stimulation. Although sustained production of aldosterone
requires persistent calcium entry through low-voltage activated Ca2+ channels, isolated
zona glomerulosa cells are considered nonexcitable, with recorded membrane voltages
that are too hyperpolarized to permit Ca2+ channels entry.[9] However, mouse zona
glomerulosa cells within adrenal slices spontaneously generate membrane potential
oscillations of low periodicity; this innate electrical excitability of zona glomerulosa cells
provides a platform for the production of a recurrent Ca 2+ channels signal that can be
controlled by angiotensin II and extracellularpotassium, the 2 major regulators of
aldosterone production.[9] Angiotensin II originates from plasmatic angiotensin I after the
conversion of angiotensinogen by renin produced by thejuxtaglomerular cells of
the kidney.[10]

The expression of neuron-specific proteins in the zona glomerulosa cells of human

adrenocortical tissues has been predicted and reported by several authors [2][11][12] and it
was suggested that the expression of proteins like the neuronal cell adhesion
molecule (NCAM) in the cells of the zona glomerulosa reflects the regenerative feature of
these cells, which would lose NCAM immunoreactivity after moving to the zona
fasciculata.[2][13] However, together with other data on neuroendocrine properties of zona
glomerulosa cells, NCAM expression may reflect a neuroendocrine differentiation of these
cells.[2] 

Paraffin sections of human adrenals immunostained forneuronal cell adhesion molecule (NCAM). Immunohistochemistry was carried out using 4-amino-9-

ethylcarbazole(AEC; Dinanova, Hamburg, Germnay) and were counterstained with hematoxylin. Staining for NCAM was restricted to the zona

glomerulosa (zg) and the adrenal medulla (m); a: x 20; b: x 200.[2]

Zona fasciculata

Situated between the glomerulosa and reticularis, the zona fasciculata is responsible for
producing glucocorticoids, such as 11-deoxycorticosterone, corticosterone, and cortisol in
humans. Cortisol is the main glucocorticoid under normal conditions and its actions
include mobilization of fats, proteins, and carbohydrates, but it does not increase under
starvation conditions.[10]Additionally, cortisol enhances the activity of other hormones
including glucagon and catecholamines. The zona fasciculata secretes a basal level of
cortisol but can also produce bursts of the hormone in response to adrenocorticotropic
hormone (ACTH) from the anterior pituitary.
 Zona reticularis

The inner most cortical layer, the zona reticularis produces androgens,

mainly dehydroepiandrosterone (DHEA), DHEA sulfate(DHEA-S),
and androstenedione (the precursor to testosterone) in humans.[10]
Medulla[edit]

Main article:  Adrenal medulla

The adrenal medulla is the core of the adrenal gland, and is surrounded by the
adrenal cortex. It secretes approximately 20% noradrenaline (norepinephrine)
and 80% adrenaline (epinephrine).[10]The chromaffin cells of the medulla, named
for their characteristic brown staining with chromic acid salts, are the body's
main source of the circulating catecholamines adrenaline and noradrenaline.
Catecholamines are derived from the amino acid tyrosine and these water-
soluble hormones are the major hormones underlying the fight-or-flight
response.

To carry out its part of this response, the adrenal medulla receives input from
the sympathetic nervous system through preganglionic fibers originating in
the thoracic spinal cord from T5–T11.[14]Because it is innervated
by preganglionic nerve fibers, the adrenal medulla can be considered as a
specialized sympathetic ganglion.[14] Unlike other sympathetic ganglia, however,
the adrenal medulla lacks distinct synapses and releases its secretions directly
into the blood.

Cortisol also promotes epinephrine synthesis in the medulla. Produced in the

cortex, cortisol reaches the adrenal medulla and at high levels, the hormone can
promote the upregulation ofphenylethanolamine N-methyltransferase (PNMT),
thereby increasing epinephrine synthesis and secretion. [5]

Blood supply[edit]

Although variations of the blood supply to the adrenal glands (and indeed the
kidneys themselves) are common, there are usually three arteries that supply
each adrenal gland:

 The superior suprarenal artery is provided by the inferior phrenic artery

 The middle suprarenal artery is provided by the abdominal aorta

 The inferior suprarenal artery is provided by the renal artery

Venous drainage of the adrenal glands is achieved via the suprarenal veins:

 The right suprarenal vein drains into the inferior vena cava

 The left suprarenal vein drains into the left renal vein or the left inferior
phrenic vein.

The suprarenal veins may form anastomoses with the inferior phrenic veins.

Since the right supra-renal vein is short and drains directly into the inferior vena
cava it is likely to injure the latter during removal of right adrenal for various
reasons.

The adrenal glands and the thyroid gland are the organs that have the greatest
blood supply per gram of tissue. Up to 60 arterioles may enter each adrenal
gland.[15] This may be one of the reasons lung cancer commonly metastasizes to
the adrenals.

Diseases involving the adrenal glands[edit]

 Several adrenal tumors cause symptoms because they result in the over- or

underproduction of certain hormones by the adrenal gland.

 In hyperaldosteronism the adrenal glands produce too much aldosterone.

 In pheochromocytoma the adrenal glands secretes excessive amounts of
catecholamines.
 In endogenous Cushing's syndrome the adrenal glands produce too much
cortisol.
 Adrenal insufficiency denotes a group of diseases characterized by
underproduction of cortisol or aldosterone. They can be caused by
problems in the adrenal glands themselves, or by impairment of the pituitary
gland or hypothalamus. The ACTH stimulation test may assist in diagnosis.
 Addison's disease is a rare disorder in which the adrenal glands do not
produce sufficient amounts of glucocorticoids (mainly cortisol). This can
be caused by an autoimmune reaction, by certain infections or by some
other rarer causes.
 Congenital adrenal hyperplasias are genetic defects of enzymes
involved in cortisol production and can affect sex characteristics of
affected patients.
 Waterhouse–Friderichsen syndrome is adrenal gland failure due to
bleeding into the adrenal glands, caused by severe bacterial infection.
 Isolated hypoaldosteronism can rarely occur due to aldosterone
synthase deficiency
 Absent adrenal gland, rare congenital condition

Terminology[edit]
The adrenal glands are named for their location relative to the kidneys. The term
"adrenal" comes from ad- (Latin, "near") and renes (Latin, "kidney").[16] Similarly,
"suprarenal" is derived fromsupra- (Latin, "above") and renes.

See also[edit]

 Addison disease

 Adrenocorticotropic hormone
 Cushing’s syndrome
 Pheochromocytoma

References[edit]

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