Adrenal Glands

Question 1

Where are the adrenal glands located?

Answer 1

Found within renal perinephric fascia (fascia attaches to crura of the diaphragm).

Separated from kidneys by perirenal fat.

Question 2

Describe the R + L adrenal gland shapes and general location (which organs are they near?)

Answer 2

Right: Pyramid shape. Near right lobe of liver.

Left: (Larger): Semilunar shape. Near stomach, pancreas, spleen.

Question 3

Describe the embryological differences of the adrenal cortex and medulla.

Answer 3

Cortex: Mesoderm

Medulla: Neural crest cells

Question 4

Describe the blood supply of the adrenals (arteries)

Answer 4

Superior adrenal arteries: From inferior phrenic artery near solar plexus

Middle adrenal artery: From abdominal aorta, adjacent to celiac trunk

Inferior adrenal artery: Branches off renal artery.

Question 5

Describe the general venous drainage of L vs R adrenal

Answer 5

Left: Left adrenal vein > left renal vein > IVC

Right: Right adrenal vein > IVC

Question 6

Describe the lymph drainage of adrenals

Answer 6

Drain to lumbar lymph nodes via adrenal lymphatic vessels; vessels originate from 2 lymphatic plexuses (1 in cortex, 1 in medulla).

Drains to cisterna chyli, thoracic duct to L subclavian vein

Question 7

Describe the nerve supply of the adrenal glands

Answer 7

Primary innervation via sympathetic nervous system to the chromaffin cells of adrenal medulla.

Sympathetic Supply:

• Arise from splanchnic nerves and celiac plexus
• Preganglionic fibers originate from T5-T11 and terminate in medulla
• No synapses to postganglionic fibers

Question 8

Fetal adrenal hormones are needed for prenatal development of organs, especially _______ maturation, as they signal the release of _______.

Answer 8

Fetal adrenal hormones are needed for prenatal development of organs, especially LUNG maturation, as they signal the release of SURFACTANT.

Question 9

What is adrenarche?

Answer 9

• Early stage of sexual maturation.
• Zona reticularis begins to enlarge.
• Adrenals secrete more androgens.
• Starts around age 6-8, peaks around 10-14.
• Results in pubic hair, body odor, skin oiliness, acne.

Question 10

What is adrenopause?

Answer 10

• Decline in secretion of adrenal androgens
• Peak secretion around 20-25Y, then declines 2%/year
• Levels at 80Y, only 10-20% remaining
• Caused by involution of zona reticularis

Question 11

What is the function of chromaffin cells?

Answer 11

Modified sympathetic ganglion cells, lacking dendrites and axons.

Synthesize and store epinephrine and norepinephrine

Question 12

Name the 3 adrenal cortex layers and the main steroids they produce.

Answer 12

• Zona Glomerulosa: Mineralocorticoids (Aldosterone)
• Zona Fasciculata: Glucocorticoids (Cortisol)
• Zona Reticularis: Androgens (DHEA)

Question 13

What is the General Adaptation Syndrome?

Answer 13

How organisms respond to stress. 3 stages;

1. Alarm
2. Resistance
3. Recovery/Exhaustion

Question 14

General support (non-pharmacologic) for General Adaptation Syndrome phases (3)

Answer 14

1. Alarm: Nervines, GABA
2. Resistance: Sedating adaptogens (Ashwagandha, bacopa)
3. Exhaustion: Stimulating adaptogens (Rhodiola, Shisandra)

Question 15

Stress and disease can lead to ________ dysregulation

Answer 15

Stress and disease can lead to HPA-AXIS dysregulation

Question 16

Chronic over-activated HPA-axis leads to:

Answer 16

Atrophy of the hippocampus (decreased memory) , depression, mood disorders

Question 17

Chronically under-activated (flattened) HPA-axis conditions:

Answer 17

Chronic fatigue syndrome (CFS), PTSD, insomnia, burnout

Question 18

Adrenal Stress Index tests ______ samples (#) times per day

Answer 18

Adrenal Stress Index tests SALIVA samples 4 times per day

Question 18

Adrenal Stress Index tests ______ samples (#) times per day

Answer 18

Adrenal Stress Index tests SALIVA samples 4 times per day

Question 19

(T or F) Cortisol is hydrophilic, and is mostly carried by plasma proteins

Answer 19

True

Question 20

(T or F) Cortisol half-life is 60-90 mins, and is determined by extent of plasma binding and by rate of metabolic inactivation

Answer 20

True

Question 21

80% of cortisol is bound by this carrier protein

Answer 21

Corticosteroid-binding globulin (CBG) aka “Transcortin”

Question 22

Increased CBG levels in:

Answer 22

• High estrogen states (pregnancy, birth control)
• Hyperthyroidism
• T2DM, insulin resistance
• Genetic disorders

Question 23

Decreased CBG in:

Answer 23

• Hypothyroidism
• Protein deficiency states (liver disease, nephrotic syndrome)
• Genetic disorders (familial CGB deficiency)

Question 24

10% of cortisol is bound to what carrier protein

Answer 24

Albumin

Question 25

(T or F) Bound steroids are biologically inactive. Only the free fraction is active.

Answer 25

True

Question 26

(T or F) There are cortisol binding proteins in saliva

Answer 26

False, saliva reflects free cortisol

Question 27

Describe A+P of glucocorticoid receptors

Answer 27

* Found in nearly every cell in body * Unbound receptors in cytoplasm * Usually bound to heat shock proteins * Binding of cortisol to GR releases the hsp

Question 28

Binding of glucocorticoids to GR can induce 2 responses:

Answer 28

* **Non-genomic cell signaling**: (fast, sec to mins). Via activation of kinases, which phosphorylate enzymes * **Genomic cell signaling**: Regulates gene expression (slower) via binding to transcription factors. mRNA products (proteins) made

Question 29

Glucocorticoid receptor agonists

Answer 29

Cortisol, synthetic GCs (prednisolone, dexamethasone), corticosterone, aldosterone

Question 30

Glucocorticoid receptor antagonists

Answer 30

Progesterone, testosterone, 17beta-estradiol, 11-deoxycortisol, mifepristone