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The Adrenal Glands Part Ⅰ The Adrenal medulla

The Adrenal Glands Part Ⅰ The Adrenal medulla

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The Adrenal Glands Part Ⅰ The Adrenal medulla

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  1. The Adrenal Glands PartⅠThe Adrenal medulla Ziying WANG Institute of Pharmacology School of Medicine, Shandong University wangziying@sdu.edu.cn

  2. Part 1 Introduction

  3. Adrenal Glands

  4. Blood supply

  5. Nerve supply AD

  6. Embryology of the adrenal gland

  7. Part 2 Adrenal medulla At the interface between the neural and endocrine system

  8. 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 (↑ ↑ ↑ ↑)

  9. Composed of polygonal cells arranged in cords or cluster Numerous wide diameter capillaries Sympathetic ganglion Adrenal medulla

  10. Brownish cytoplasm granules- when fixed by chromate salt containing fixative Also called chromaffin cell Adrenal medulla chromate salt stain

  11. Hormones of adrenal medulla Adrenaline Catecholamines Noradrenaline Dopamine Opiate peptides Peptides Adrenomedullin Arginine vasopressin Vasoactive intestinal peptide

  12. Catecholamine (CA)

  13. Synthesis of catecholamine

  14. Synthesis of catecholamine • PNMT • Regulated by glucocorticoids.

  15. Secretion of catecholamine

  16. Regulation of catecholamine secretion • The activity of the adrenal medulla is regulated by the activity of the sympathetic nerve.

  17. 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

  18. Actions of adrenal medullary hormones • Fight and flight neuroendocrine response • Emergency reaction hypothesis: W. B. Cannon, 1928 • Through activating adrenoceptors

  19. 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 (↑ ↑ ↑ ↑)

  20. Part 3 Disorders of the adrenal medulla Phaeochromocytoma: a tumor causes adrenal medullary hormones over-secretion

  21. 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

  22. Case: treatment (1) Drug treatment:α-blockers→β- blockers (2) To find the source: CT and MIBG scan (3) Operation

  23. Familial Phaeochromocytoma

  24. Part 3 Pharmacological uses of adrenal medullary hormones

  25. Clinical usesof adrenaline 1. Cardiac arrest 2. Allergic shock: first choice 3. Bronchial asthma 4.Prolongation of local anesthetic duration 5. Topical hemorrhage

  26. 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

  27. Clinical usesof NA • Shock and hypotension 2. Upper digestive tract hemorrhage

  28. Endocrine hypertension Belongs to secondary hypertension: Conn’s syndrome Cushing’s syndrome Phaeochromocytoma