endocrine - adrenal gland Flashcards
Complex of N/NE with ATP, Ca and proteins inside the granules.
Chromogranins
Synthesis of epinephrine
- Transport of tyrosine into chromaffin cells cytoplasm
- Hydroxylation of tyrosine into DOPA
- DOPA to dopamine
- Transport of dopamine into chromaffin granules (secretory vesicles)
- Dopa to norepi within chromaffin granules as chromogranins
- Norepi diffuses out of granule thru facilitated diffusion
- Methylation of norepi to epi
- Transport of epi back into granules
Reduces osmotic burden of storing individual molecule of epi with chromaffin granules
Chromogranins
Important in biogenesis on secretory vesicles and organization of components within vesicles
Chromogranins
Secretion of noepi and epi is regulated by
Descending sympa signals in response to stress.
Hypothalamus and brain stem send a chemical signal as ACTH to bind to nicotinic receptor in chromaffin cells which increases acty of tyrosine hydroxylase and B-hydroxylase in which stimulates exocytosis of granules
Mechanism of action of catecholamine
Exerted thru adrenergic receptor
Tissue distribution and potency agonist:
a1 receptor
Adrenergic post synaptic nerve terminals
Norepi=epi
Tissue distribution and potency agonist:
a2 receptor
Adrenergic pre synaptic terminals
Norepi=epi
Tissue distribution and potency agonist:
B1 receptor
Heart
Epi=norepi
Tissue distribution and potency agonist:
B2 receptor
Liver
Epi>norepi
Tissue distribution and potency agonist:
B3 receptor
Adipose tissue
Norepi>epi
2 primary degradation enzymes of catecholamine
- Monoamine oxidase MAO
2. Catechol-O-methyltransferae COMT
Degradation enzyme of catecholamine that predominates in neuronal mitochondria
MAO
Degradation enzyme of catecholamine that predominates as methylation of Norepi/epi in non-neuronal tissue
COMT
Degradation enzyme of catecholamine that is predominant
COMT
Metabolism of catecholamine
Draw!
Chromaffin cell tumor that produce, store, metabolize and secrete catecholamine (in excess).
Causing irregular secretion of epi and norepi leading to attacks of raised bp, palpitations, and headache.
Pheochromocytoma
Pheochromocytoma is majorly bilateral/ unilateral?
90% unilateral and sporadic
Clinical features of pheochromocytoma
Sweating Hypertension Headaches Anxiety/fear Forceful heartbeat with or without tachycardia Flushing Fatigue Tremors
In pheochromocytoma, hypertension is mainly due to
Increased peripheral resistance
In pheochromocytoma, lability of Bp is caused by
Episodic catecholamine release
Impaired Symphathetic reflex
Unrecognized chronic volume expansion
Biochemical diagnosis of pheochromocytoma
Catecholamine excess
Urinary fractionated metaphrenine or plasma free metaphrenine will predict size and location of tumor
How is blood collection done in diagnosis of pheochromocytoma?
Supine for 20min
Overnight fast
No nicotine, alcohol within 12hrs
Avoid acetaminophen, TCA and phrnoxybenzamine
Imaging of choice for pheochromocytoma
CT scan
Imaging of choice in pheochromocytoma preferred for extra adrenal, pregnant, children and those allergic to contrast.
MRI
Imaging of choice in pheochromocytoma if there is metastasis, previous operation or for familial, multiple pheochromocytoma
MIBG - 1st choice, gets into cell but not metabolized in cell
PET scan - metabolized further in cell
Largest and most Steroidogenic zone in adrenal Cortex
Zona fasciculata
Rate-limiting enzyme in Steroidogenesis
Cyp11A1
1st reaction in Steroidogenic pathway
Free cholesterol transported in inner mitochondria thru STAR protein, and converted into pregnenolone by CYP11A1
Reaction 2 in modification of FC to cortisol
Pregnenolone to progesterone by 3B-HSD or
Pregnenolone to 17-OH-pregnenolone by CYP17 (hydroxylase func)
Reaction 3 in modification of FC to cortisol
Progesterone to 17-OH-progesterone by cyp17(hydroxylase) or
17-OH-pregnenolone (^5) to 17-OH-progesterone(^4) by 3B-HSD
Reaction 4 in modification of FC to cortisol
17-OH-progesterone to 11-deoxycortisol by CYP21B
Reaction 5 in modification of FC to cortisol
11- deoxycortisol to cortisol by cyp11B1
Reaction 4 in modification of FC to corticosterone
17-Oh-progesterone to 11-deoxycorticosterone by cyp21B
Reaction5 in modification of FC to corticosterone
11-deoxycorticosterone to corticosterone by cyp11B1
Mechanism of cortisol
Glucocorticoid receptor
In the absence of cortisol, GR stays I. Cytoplasm bound to molecular chaperone such as
Heat-shock protein 90
Cyclophilin
Regulation of cortisol production
Thru Hypothalmus-ant. Pituitary-adrenal axis
ACTH binds to what receptor in zona fasciculata
Melanocortin-2 receptor
Acute effect of ACTH
- Rapid transport of cholesterol to OMM
- Increase STAR protein gene expression
- Resulting to increase pregnenolone activity
Chronic effect of ACTH
- Increase transportation of genes encoding Steroidogenic enzyme and coenzyme
- Increase LDL and HDL receptor
Cortisol serves as negative feedback thru
- Inhibition of pomc gen expression at corticotropes.
2. Inhibition of pro-CRH gene expression at hypothalamus
Metabolic action of cortisol in response to stress
Increase cortisol
Decrease insulin/glucagon ratio
Increase epi and norepi from sympathoadrenal output
Metabolic action of chronically elevated cortisol in healthy individuals
Increase cortisol
Increase insulin/glucagon ratio
Decrease epi and norepi
Zona reticularis begins to appear after birth at..
5 year old
Adrenal androgens (DHEAS) appear in circulation at
6 year old
Steroidogenic pathway in zona reticularis
Pregnenolone to 17-OH-pregnenolone (CYP17) to DHEA (CYP17 -lyase) to DHEAS (SULT2A1) or
DHEA to aldrostenedione (3B-HSD)
DHEAS/DHEA: has high affinity binding to albumin
DHEAS
DHEAS/DHEA: low affinity binding to protein
DHEA
Zona glomerulosa is primarily regulated by
RAS
Extracellular K
ANP
Zona glomerulosa is secondarily regulated by
ACTH
Unique features of zona glomerulosa
- Absence of cyp17
2. Presence of cyp11b2 (aldosterone synthase)
Steroidogenic pathways in zona glomerulosa
Pregnenolone to progesterone (3B-HSD) to 11-doc (cyp21b) to corticosterone to 18-OH-corticosterone to aldosterone (cyp11B2)
Zona glomerulosa has low affinity binding to transport proteins
True
Zona glomerulosa almost all inactivated by
Liver (conjugated to glucoronide)
Mechanism of action of zona glomerulosa
Intracellular mineralocorticoid receptor
Presence of this enzyme converts cortisol to cortisone (inactivates)
11B-HSD2
Cortisone is converted back to cortisol in liver, skin and other tissues by
11B-HSD1
Physiologic action of aldosterone in kidney
Increase NA reabsorption
Increase K and H secretion
Results from continuous administration of aldosterone in 2-3days
Aldosterone escape
Regulation of aldosterone secretion
RAAS
Renin is produced by
Juxta glomerular cell
Renin is release in response to
Low bp
Low Na delivery to macula densa
Stimulators of aldosterone
Angiotensin II = increase STAR and cyp11b2 (potent vasoconstrictor)
Extracellular K
Acute elevated ACTH
Inhibitors of aldosterone
ANP (directly inhibits aldosterone production / indirectly inhibits renin release)
Chronic elevated ACTH
What happens when there is Hypervolemia
Hypervolemia means high Na level, this will inhibit the renin release which will lower aldosterone secretion resulting back to normovolemia
Primary hyperaldosteronism
Usually due to aldosterone- secreting tumor
Conn’s syndrome
Conn’s disease results in
K depletion Na retention Ms weakness Hypertension Polyuria
Increase ACTH due to any enzyme block decreasing cortisol synthesis.
May cause masculinization of female fetus or incomplete masculinization of male fetus
Congenital adrenal hyperplasia
Congenital adrenal hyperplasia usually due to
Cyp21