Adrenal cortex

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Adrenal cortex
Layers of cortex.
Latin	cortex glandulae suprarenalis
Gray's	subject #277 1278
Precursor	mesoderm[1]
Dorlands/Elsevier	c_57/12261690

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Overview

Situated along the perimeter of the adrenal gland, the adrenal cortex mediates the stress response through the production of mineralocorticoids and glucocorticoids, including aldosterone and cortisol respectively. It is also a secondary site of androgen synthesis.

Layers

The cortex can be divided into three distinct layers of tissue based on their organization.

Layer	Name	Primary product
Most superficial cortical layer	zona glomerulosa	mineralocorticoids (eg, aldosterone)
Middle cortical layer	zona fasciculata	glucocorticoids (eg, cortisol)
Deepest cortical layer	zona reticularis	weak androgens (eg, dehydroepiandrosterone)

Steps of hormone synthesis

• All adrenocortical hormones are synthesised from cholesterol.

• Cholesterol is transported into the inner mitochondrial membrane by steroidogenic acute regulatory protein (STAR), where it is converted into pregnenolone by the enzyme CYP11A1. Accordingly, production of hormones in all three layers of the adrenal cortex is limited by the transportation of cholesterol into the mitochondria and by its conversion into pregnenolone.

• Pregnenolone can be either dehydrogenated to progesterone, or hydroxylated to 17-alpha-hydroxypregnenolone.

The steps up to this point occur in many steroid-producing tissues. Subsequent steps, however, only occur in the adrenal cortex:

• Progesterone -> (hydroxylation at C21)-> Deoxycorticosterone ->(two further hydroxylations)-> Aldosterone
• Progesterone -> (hydroxylation at C17)-> 17-alpha-hydroxyprogesterone ->(hydroxylation)-> Deoxycortisol ->(hydroxylation)-> Cortisol

Production

The adrenal cortex produces a number of different corticosteroid hormones:

• Mineralocorticoids: They are produced in the zona glomerulosa. The primary mineralocorticoid is aldosterone. Its secretion is regulated by the oligopeptide angiotensin II (angiotensin II is regulated by angiotensin I, which in turn is regulated by renin). Aldosterone is secreted in response to high extracellular potassium levels, low extracellular sodium levels, and low fluid levels and blood volume. Aldosterone affects metabolism in different ways:
  • It increases urinary excretion of potassium ions
  • It increases interstitial levels of sodium ions
  • It increases water retention and blood volume

• Glucocorticoids: They are produced in the zona fasciculata. The primary glucocorticoid released by the adrenal gland is cortisol. Its secretion is regulated by the hormone ACTH from the anterior pituitary. Upon binding to its target, cortisol enhances metabolism in several ways:
  • It stimulates the release of amino acids from the body
  • It stimulates lipolysis, the breakdown of fat
  • It stimulates gluconeogenesis, the production of glucose from newly-released amino acids and lipids
  • It increases blood glucose levels in response to stress, by inhibiting glucose uptake into muscle and fat cells
  • It strengthens cardiac muscle contractions
  • It increases water retention
  • It has anti-inflammatory and anti-allergic effects

• Androgens: They are produced in the zona reticularis. The most important androgens include:
  • Testosterone: a hormone with a wide variety of effects, ranging from enhancing muscle mass and stimulation of cell growth to the development of the secondary sex characteristics.
  • Dihydrotestosterone (DHT): a metabolite of testosterone, and a more potent androgen than testosterone in that it binds more strongly to androgen receptors.
  • Androstenedione (Andro): an androgenic steroid produced by the testes, adrenal cortex, and ovaries. While androstenediones are converted metabolically to testosterone and other androgens, they are also the parent structure of estrone.
  • Dehydroepiandrosterone (DHEA): a steroid hormone produced from cholesterol. It is the primary precursor of natural estrogens. DHEA is also called dehydroisoandrosterone or dehydroandrosterone.

Mnemonics

The layers of the cortex can be remembered with the mnemonic GFR: G - glomerulosa, F - fasciculata, R - reticularis.

Another mnemonic that is used is Go Find Rex, Make Good Sex: G - glomerulosa, F - fasciculata, R - reticularis, M - mineralcorticoids, G - glucocorticoids, S - sex hormones. (This mnemonic simplifies the relationship between the locations of production of glucocorticoids and sex hormones.)

Another mnemonic is "Salt, Sugar, Sex: The deeper you go, the sweeter it gets." As one moves layers into the adrenal cortex, compounds that control salt (mineralcorticoids), sugar (glucocorticoids), and sex (weak androgens) are produced.

Pathology

• Adrenal insufficiency (e.g. due to Addison's disease)
• Cushing's syndrome
• Congenital adrenal hyperplasia
• Conn's syndrome

See also

• Adrenal gland

References

External links

• SUNY Labs 40:04-0203 - "Posterior Abdominal Wall: Blood Supply to the Suprarenal Glands"
• Mnemonic at medicalmnemonics.com 180 2201 412
• Histology at BU 14502loa
• Anatomy Atlases - Microscopic Anatomy, plate 15.292 - "Adrenal Gland"
• Adrenal Cortex Medical Notes on rahulgladwin.com

v • d • e Endocrine system > Adrenal glands
Medulla	Chromaffin cells
Cortex	Zona glomerulosa • Zona fasciculata • Zona reticularis

de:Nebenniere#Nebennierenrinde

eo:Surrena kortekso

v • d • e WikiDoc Research Resources for Adrenal cortex (Click show to right to view)
Articles on Adrenal cortex	Most recent articles on Adrenal cortex • Most cited articles on Adrenal cortex • Review articles on Adrenal cortex • Articles on Adrenal cortex in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Adrenal cortex	Powerpoint slides on Adrenal cortex • Images of Adrenal cortex • Photos of Adrenal cortex • Podcasts & MP3s on Adrenal cortex • Videos on Adrenal cortex
Evidence Based Medicine Regarding Adrenal cortex	Cochrane Collaboration on Adrenal cortex • Bandolier on Adrenal cortex • TRIP on Adrenal cortex
Cost Effectiveness of Adrenal cortex	Cost Effectiveness of Adrenal cortex
Clinical Trials Involving Adrenal cortex	Ongoing Trials on Adrenal cortex at Clinical Trials.gov • Trial results on Adrenal cortex • Clinical Trials on Adrenal cortex at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Adrenal cortex	US National Guidelines Clearinghouse on Adrenal cortex • NICE Guidance on Adrenal cortex • NHS PRODIGY Guidance • FDA on Adrenal cortex • CDC on Adrenal cortex
Textbook Information on Adrenal cortex	Books and Textbook Information on Adrenal cortex
Pharmacology Resources on Adrenal cortex	Dosing of Adrenal cortex • Drug interactions with Adrenal cortex • Side effects of Adrenal cortex • Allergic reactions to Adrenal cortex • Overdose information on Adrenal cortex • Carcinogenicity information on Adrenal cortex • Adrenal cortex in pregnancy • Pharmacokinetics of Adrenal cortex •
Genetics, Pharmacogenomics, and Proteinomics of Adrenal cortex	Genetics of Adrenal cortex • Pharmacogenomics of Adrenal cortex • Proteomics of Adrenal cortex
Newstories on Adrenal cortex	Adrenal cortex in the news • Be alerted to news on Adrenal cortex • News trends on Adrenal cortex
Commentary on Adrenal cortex	Blogs on Adrenal cortex
Patient Resources on Adrenal cortex	Patient resources on Adrenal cortex • Discussion groups on Adrenal cortex • Patient Handouts on Adrenal cortex • Directions to Hospitals Treating Adrenal cortex • Risk calculators and risk factors for Adrenal cortex
Healthcare Provider Resources on Adrenal cortex	Symptoms of Adrenal cortex • Causes & Risk Factors for Adrenal cortex • Diagnostic studies for Adrenal cortex • Treatment of Adrenal cortex
Continuing Medical Education (CME) Programs on Adrenal cortex	CME Programs on Adrenal cortex
International Resources on Adrenal cortex	Adrenal cortex en Espanol • Adrenal cortex en Francais
Business Resources on Adrenal cortex	Adrenal cortex in the Marketplace • Patents on Adrenal cortex
Informatics Resources on Adrenal cortex	List of terms related to Adrenal cortex

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .