So the adrenal gland, okay, this is also known as the suprarenal gland because of where it's located. Supra because it's superior and renal for the kidneys. So this is also, this is called suprarenal glands because they're found on top of the kidneys. Okay, either one is fine, adrenal gland or suprarenal gland. Now, similar to the pituitary gland, where the pituitary gland is actually two glands, posterior pituitary and anterior pituitary, similarly, the adrenal glands are the same thing.
It's really two glands. There's an inner medulla that's going to release two hormones, and then there's an outer, what we call cortex, and that's going to release three different hormones. Okay?
So let's talk about the adrenal cortex first. Adrenal cortex is broken down into three things. I'm going to give you a little mnemonic after I go over the adrenal gland, how to memorize this stuff once hormones come out.
Let me just explain to you in this form what these words are. The adrenal cortex has three layers itself. So the layers upon, you know, subtype layers.
So you have the adrenal gland, broken down into the adrenal medulla, which is the center part, and then the outer layer, which is called the adrenal gland. adrenal cortex. The adrenal cortex is broken up into three layers. The outermost layer is known as the zona glomerulosa and that's going to release a lot of what we call mineral corticoids.
Of the mineral corticoids, the most abundant one is something called aldosterone. The middle layer of the adrenal cortex is known as the zona fasciculata. And they're going to synthesize a group of hormones called glucocorticoids. And the most abundant glucocorticoid that we're going to be speaking about is something called cortisol. And the most deeper layer of the adrenal cortex is called the zona reticularis.
And they're going to release a group of hormones called gonadocorticoids. If you're thinking gonadal, think of gonads, and yes, they're going to be dealing with something with the gonads. They're going to be releasing a hormone, mainly androgens. Now androgens, we're going to talk about, are basically precursors to testosterone.
And testosterone is a precursor to become estrogen. Just hold that, when we get into it, you'll understand a little bit more. So this is how it's broken down.
You've got the capsule layer out there. The capsule layer of the adrenal cortex is just connective tissue to kind of hold the whole thing together. It doesn't release anything.
It's just like a connective tissue to hold it all together. then we have this zone of lumary ulcer right underneath that that releases the aldosterone. Then you have the zona fasciculata that's going to release the cortisol and then you have the zona reticularis which is going to be released in androgens and then underneath that you will have the adrenal medulla, the core of the adrenal gland.
The adrenal medulla is going to release, if you remember from A and P1, they're going to release epinephrine and norepinephrine, our catecholamines. Now, the adrenal cortex. Let's talk about the three hormones.
Aldosterone. Aldosterone is going to regulate electrolyte balance. Now think of it like this. I've done something similar like this with ADH.
But you have aldosterone. Okay? Aldosterone, when it gets released and it targets the kidney, What that's going to do is that that is going to reabsorb sodium. It's going to make sodium go into the bloodstream from the kidney.
Now, think about what's happening here. Sodium is going into the kidney. I'm sorry, sodium is going into the bloodstream. Is that making the bloodstream more concentrated or less concentrated? concentrated more concentrated right putting more salt in your water it's gonna get more concentrated it's gonna get more concentrated that's not a good thing for the bloodstream it changes things when we get into fluids and electrolytes you'll see what I'm talking about so we don't like that So for every ion of sodium that gets reabsorbed into the bloodstream, to keep the concentration of the bloodstream adequate, we also are going to increase one molecule of water.
Sodium goes in, water goes in. Okay? Does that make sense?
To keep the concentration. Now, if you increase the water into the bloodstream, what's going to happen to the blood volume? It increases, right? If you increase the blood volume, what's going to happen to blood pressure? It goes up.
It's pretty easy to understand that aldosterone increases blood pressure. How? Because it reabsorbs sodium, water is going to follow, that increases the blood volume, which increases the blood pressure. Okay?
This is the way you should be thinking. Soon enough, you can do this all in your head and you can say, aldoxuron increases blood pressure because it reabsorbs sodium. Now, I showed you before how ADH increases blood pressure.
That's different, right? It does it by increasing blood volume, but it just reabsorbs water, not sodium. This is dealing with electrolytes. Okay?
Now, we've got a problem, Houston. And even though we just corrected... the concentration of the bloodstream didn't correct the charge.
You see, we're bringing sodium in. Water's going to follow, so the concentration will be there. But is the blood more positive, more negative, or is it a change? It's more positive.
You see that? Because sodium came in, that's going to make it more positive. So then that's going to change things also. You know anything about, we talked about action potentials and stuff.
If you change the outside... more positivity outside it's going to Adjust and it's going to Alter the action to the potential to the action potential, right? So we've got to do something else We've got to get rid of a positive charge if we're putting a positive charge in. So what aldosterone is also going to do is it's going to secrete a positive charge.
Now it's not going to secrete sodium, they just put it in there. So it's going to secrete potassium. Now the charge is okay. Now the concentration is okay. Does that make sense?
See how you're using that? Okay. So our Darshan is going to reabsorb sodium. Water is going to follow. That increases the blood pressure.
And it's also going to secrete, by the kidney, it's going to secrete potassium. You can imagine that if you have a tumor of the aldosterone, where the aldosterone is coming from, you're going to be low in potassium, which can apply to blood pressure. See how you're using this. Okay? Now what will make aldosterone come out?
If you have a high level of potassium in the bloodstream, that's going to make it come out so that we can spit out or secrete potassium. If we have low levels of sodium in the blood, that's going to make more sodium go in. Or if you have hypotension, these are things that are going to stimulate how potassium will come out. Now, if you have... High potassium, that's going to make aldosterone come out, right?
If you have low sodium in the bloodstream, that's going to make aldosterone come out to put sodium in. Low potassium, I'm sorry, high potassium is going to make aldosterone come out to decrease potassium. See it? And if you have...
We'll say hypotension. or low blood pressure, that too is also going to make the aldosterone come out. See that?
And then it'll correct it, or try to correct it. It's the thermostat in our body, the teeter-totter, right? The blood pressure goes too low, this is going to make it go up, vice versa right So again, it's going to reabsorb sodium, water is going to follow, that's going to increase blood volume, which increases blood pressure. It will also secrete potassium.
Okay? Questions about that? We're going to revisit this many times throughout A&P 2 because we're going to deal with blood pressure, we've got to talk about aldosterone, ADH again, and we're going to get into kidney because that's where it's going to target.
Now if this goes, if this is high, all right, if this is high, let's say normal is let's say 4, 4.0, you don't have to worry about the numbers, but if it's 6.0, that's pretty high. So we got to get rid of that potassium. Aldosterone will come out and it's going to decrease the potassium.
Does that make sense? As a side effect, it's going to increase sodium and make blood pressure go up too. But yeah. What's that? Decrease this.
Yeah, when I say secrete, oh, alright, reabsor- the kidney does two things. It's either going to reabsorb things back into the bloodstream, or it's going to secrete things from the bloodstream and go into your pee. I'm sorry, I'm sorry. Alright, we say the word secretion because it's going to go out into urine.
Okay, so yeah, so this is, I'm sorry to confuse you. So when I say we're going to decrease potassium from the bloodstream, we say the words, you're kidding, secretes it out into urine. Sorry about that. Is that clear? Okay?
And then this is going to reabsorb it. Because it came from, where did sodium come from? It came from the bloodstream. So it goes into the kidney and it gets reabsorbed.
Going back to where it came from. Is that clear? Yeah, so when I say reabsorption, the sodium came from the bloodstream into the kidney, but now the kidney's going to put it back into the bloodstream. So you're going to reabsorb it.
You're not absorbing it, it's a first time. It's going back in there from where it came from. And when I say the kidneys secrete, it's secreting it into the urine.
You pee it out, which means it's going to decrease potassium from the bloodstream. It's really getting outside the body. Am I clear? Sorry about that, yeah.
But when you have really tension, it's not a question of... Tension of sodium. Yeah.
Yeah, but it gets... If this gets high, you're going to find out that you'll die. You'll have a heart attack. But I don't want to get into that just yet. Okay?
It does other things too. Okay, questions about that? Okay, so a few things on here.
Aldosterone is released by three different mechanisms. Okay, one, you've seen the concentration of potassium or the concentration of sodium, whether increase of potassium or decrease of sodium, that's going to make it come out. ACTH, where does ACTH come from? It's a hormone. The anterior pituitary, right?
If that comes out, it's going to go into the adrenal cortex and it's going to make it come out. Then there's also something that I'm going to go over briefly with you now, but we'll go into it many times throughout the whole semester. It's something called the renin-angiotensin aldosterone mechanism. I'll show you what that is if you have a picture of it afterwards.
But that's going to be the decrease of blood pressure, kidneys release renin. Renin is a hormone slash enzyme, and I'll explain that later. it's going to make angiotensin 2 come out, which I'll talk about, and that will make the aldosterone come out. So really what I wrote here is the same thing.
So you have low blood pressure is going to make aldosterone come out. The potassium or sodium concentration is going to make it come out. And then also, which I think right up here, ACTH is also going to make aldoxine come out.
I think when you take all these hormones and you isolate each one, they're not bad. It's when you get 35 hormones, it gets overwhelming. Now, one other thing I want to mention too, there's a hormone that the heart...
release it. Yes, the heart is then considered not just a part of the cardiac system or the cardiovascular system, it's also part of the endocrine system. There's a hormone that comes out called the atrial natriatic hormone, also referred to as the atrial natriatic peptide. This is an interesting one.
As blood goes into the heart, if the blood pressure is very high, It tells the... The first chambers of the heart called the atria to release the hormone called AMP. This is going to get released from the heart. It's going to target the adrenal cortex and tell aldosterone to stop coming out. It inhibits aldosterone.
So what we've got over here is atrial netriatic peptide, or hormone. is going to give inhibition to it. These will all stimulate it, but H-1-nitrate of peptide is going to inhibit it.
And this, as far as I know, I think this is the only hormone, when it gets secreted, that it directly decreases blood pressure. When things usually get released, they would increase blood pressure. Aldosterone, increase blood pressure.
We'll learn about cortisol, increase blood pressure. We have ADH, increase blood pressure. This one, when it comes out, it decreases blood pressure. How?
Because it inhibits aldosterone. Okay? Questions about that?
Alright, and this is just showing you, in essence, all the different ways that abduction comes out. So you can do that on your own. All these kinds of flowcharts I usually don't do in class because it's really self-explanatory. When you look at it for about five or ten minutes at home, it still makes sense.
You just, this leads to this, leads to this, and so on. Okay? Now, if you have...
Too much aldosterone. It kind of makes sense what's going to happen. This is a disease called Kahn's disease, when it releases a lot of aldosterone.
So if you increase the aldosterone, think what's going to happen. You're going to increase more sodium in the bloodstream, which means more water is going to follow, which means you're going to have a lot of blood volume increasing, which means you're going to have hypertension or high blood pressure. Makes sense, right? You'll also have a lot of sodium in the bloodstream and you'll have, because the potassium is going to leak out so much or is to creep out into the urine, you're going to have low potassium which leads to muscle weakness. Does that make sense?
You have a tumor of the... Adrenal glands specifically involving the aldosterone mechanism, the zona glomerulosa. That will increase your blood pressure, you'll have high sodium and low potassium in the blood. Okay. Some women when they get pregnant, they have high blood pressure.
That's different. That's a totally different mechanism. You've got to understand, there's a good question.
There's a lot of reasons why people have high blood pressure. Hans disease is a rare... thing. I'm only talking about Cahn's disease because I'm talking about aldosterone.
A lot of reasons why. In pregnancy, there's a lot of reasons which I won't go into. But there's a lot of reasons we'll get into. If you have a tumor of the ADH, that's going to increase. blood pressure right stress is going to increase blood pressure there's many different ways because we have many different ways that look for the high blood pressure occurs with many different ways that we can try to control it you will see a lot when you get into pharmacology in your future classes there is a lot of anti-hypertensive medication and how do they work I need to understand all these different Each one deals with different mechanisms of how this happens.
There's a lot of different mechanisms. And that's what A and B do. When we get to the end, by the end of the course, you'll see there's a lot of mechanisms that we've gone through. Okay? Alright, when you have too little aldosterone in the system, Then you're going to have low blood pressure, right?
If you decrease the valgostron, it means you're going to decrease sodium into the bloodstream. Decrease of water will follow. Decrease of blood volume means you're going to have hypotension. and full of electrolyte pressure. But that means your potassium is going to go up.
It's not a good thing. That's probably the most serious electrolyte imbalance that we have. Electrolyte imbalances are bad. altogether but this going up we're going to show you it causes cardiac arrest okay we'll get into that later so if you have a decrease of aldosterone you'll have hypotension you'll have high levels of potassium we call it hyperkalemia that's where the K comes in and hyponatremia natremia is the amount of sodium that's where the na comes in Right? Sodium, the amount of sodium in the...
Okay? Sound good on that? Why is it called Khan?
There's two ways that you can get a disease name after someone. You either die from it, or the person who discovered it. And it was... I don't know who Khan was, if it was the...
the physicist that... saw it first or the person who died from it. I'd rather be the doctor that discovered it and died from it. Similarly, like Lou Gehrig's disease. It was the baseball player that died from it until they called it that.
A lot of these, they're called eponyms, where they have these weird names, cons of these and stuff. But cons of these is on this one. Okay.
Questions about aldosterone? Okay, so let's talk about cortisol. Alright, cortisol maintains the body's ability to counteract stress.
When your body gets stressed, it's going to need glucose into the bloodstream. Now, What's one hormone besides cortisol that will increase glucose into the bloodstream? Epinephrine does too, yes, but it's also due to stress. I'm not going to, we'll talk about that in a moment, but what's the other one that we have already talked about that comes from the pancreas?
Glucagon, right? Glucagon is going to increase glucose in the bloodstream. but a different stimulation.
Meaning, what's going to make glucagon come out? Low blood sugar. Okay? Low blood sugar tells the pancreas to secrete glucagon to go into the Big iceberg of glucose that I said we call glycogen, right? It's in the liver and some muscle.
And it starts chipping away at that iceberg and little ice cubes of glucose go into the bloodstream. So low levels of glucose... make glucagon come out to increase blood levels of glucose. Okay? That takes some time to occur.
Minutes to hours. Okay? That's not good when you get stressed. A bear is chasing you.
You don't have time for glucagon to do its job. You need something faster to get glucose into the bloodstream to go into your muscles, to go into the brain, and to think of where should I run to, right? So you need some kind of thing that's going to happen quicker.
Cortisol does this. It doesn't last that long, but you get this big burst of glucose into the bloodstream because of this. Does this make sense?
When your body is under stress... Take for instance, one of my quizzes or exams. Okay?
You don't want to wait for the glucose to go up because you just had your breakfast like half an hour ago and the sugar hasn't gone up. You want your body under stress to give this big burst of glucose into your bloodstream so you can manage one of the exams. Right?
That's what cortisol does. Okay? It breaks down glycogen from stress stimulation. Alright? And that's not...
Stimulated by low levels of glucose you get it because of this stress and it does all these wonderful things I'm trying to get glucose into the bloodstream It's going to do that gluco me of Genesis right to make amino acids into glucose make a new new synthesis of Glucose so that's going to increase glucose We're going to take the fat from your body, and it's going to break it up to call it like policies, right? converts it triglycerides and turns them into fatty acids, which we'll talk about with the digestive system, more energy, okay? It's going to need to break up proteins also.
When the proteins are broken up, they turn into amino acids that can fuel gluconeogenesis to make more glucose, okay? It's also gonna vasoconstrict blood vessels. So if we're in a room of blood, right, we're in a blood vessel, take the walls and the ceiling and the floor, and we start constricting it, all the water molecules, which is represented by you students, is going to get closer and closer together, which means the pressure goes up. Okay, so vasoconstriction causes blood pressure to go up. It also has a phenomenal thing, which is increases anti-inflammatory This is something that I'm just going to talk about for a minute or two.
I want you to see what's going on with it. What's going to happen here is that when more cortisol comes out, your immune system goes down. This kind of makes sense.
I'm going to sound like a little Dr. Oz. When you're more stressed, you tend to get sicker. Colds, get more stomach aches, those kinds of things.
Why? Because your immune system is going down, so when you have a cold virus coming in, you're not going to be able to fight it as well. Does that make sense?
Okay? So when I was in medical school, what I ended up doing, because I knew about this, was taking a vitamin a day, just a multivitamin, just to give myself the extra boost of vitamin C, which you'll learn about later. You know, that helps the immune system. Was it head of health? Yeah, I mean I went to school in Grenada in the Caribbean island, I probably got jagella and stuff by the foods I ate, but that's okay, that's different.
But it's just, we use this for other things, because we can also use a medicine called cortisone, prednisone. These are words you've probably heard about. These are cortisol vapes. Now we're not giving it to increase glucose. We're giving it because we want to decrease your immune system on purpose.
You have arthritis. It ends with ITIS. It's inflammation.
Immune response. Well if your arthritis is so bad, your immune response is happening so good. Well we want to decrease it so that you don't have that swelling there due to the inflammation. So we'll give you a shot of a cortisone shot in that area so that whole area will actually decrease in the immune system so that the arthritis gets better.
Does that make sense? All right we like to give cortisone shots locally meaning like we're going to give it in the knee as opposed to taking it by mouth so now systemically it goes throughout your whole body. There's a lot of side effects with this.
You can get diabetes from this. A temporary thing. Why? Because your glucose is going up. You can't control it.
You see that? You get high blood pressure with this too. You're on it for a long time. You've got basal constriction.
That's what's happening there. So we'd rather just locally give it to you if it's possible so that it stays in that area. You don't want to have it throughout your whole body.
In certain cases... Yes, you've got to have it throughout your whole body. In certain cases, let's say lupus, because lupus affects the whole body. So you'll be taking cortisone called prednisone in the mouth, so that affects your whole body.
But if you know anything about prednisone or any of these oral steroids, we call them the steroid medication. Not steroids like anabolic steroids. But this, they're usually on, or prednisone, they're only on for a short amount of time.
...like 10 days. You don't want to put them on for a long time because you get a whole slew of things. They actually will increase osteoporosis, blood pressure, retention of a bunch of different things. on a short amount of time.
Sure, there's certain people that need it for a long amount of time, but then they're going to be like months and months, they will be monitored for all this kind of stuff and adjust things accordingly. I don't want to go into details all this, I just want you to understand what cortisone shots are and why they would be given it. Are we clear with that?
Okay? I want to emphasize, hint hint, make sure you know about these because you're going to see these in your future classes. I need to make sure you know this. Now, one other thing is this that I want you to understand.
A person is a diabetic, all right, diabetes mellitus. And now, for some reason, they're giving her corticosteroids. No, I'm sorry, I'm sorry. Let's just do this one. Let's do this one.
Here's a woman who's a diabetic, okay? And now she gets an infection. Now, when I say stress, You're thinking of the only thing that stress is, is like one of my exams.
But your body goes through many different stresses that you don't consider stresses. For instance, you're going under the knife for surgery. You may not feel the pain, but your body does.
So your body goes under stress for any kind of surgery. If you have an infection... shingles or just a runny nose you have some sort of infection, pneumonia, that's also stress on the body.
Does that make sense? So now you have a diabetic who is controlling it with insulin and all of a sudden she's got pneumonia. Now she notices that her sugar level is very high. Whoa!
I know I'm eating properly. I know I'm giving my right injections for the insulin. I'm taking the pills for diabetes. Why is my sugar going up?
Why is the sugar going up for a diabetic who has pneumonia? Sure, their body's under stress, cortisol comes out. cortisol comes out the sugar levels in the blood increase. Does that make sense?
Alright this is a very important thing you need to understand. Alright where is this extra sugar coming from? It's coming from the adrenal cortex from cortisol that's going to increase it.
Very important if you know that your father's a diabetic and he has to go for a hernia surgery The doctor will tell you exactly what you should take for the insulin Because when you're under the knife under anesthesia, your sugar levels are going to go up and the anesthesiologist is going to adjust that. I don't want to say what he's going to tell you to do in the morning of because it depends on the situation, but it's very important if you're a diabetic to listen to the doctor and say, you know, ask him, you are supposed to take this normal dosage of insulin or not because your sugar levels are going to change, more or less it's going to increase during the surgery. has to be fixed.
Okay? Questions about that? I spent a lot of time on that so chances are there's going to be a question or two on the test.
I want you to understand the concept why sugar levels go up under stress. What that stress is. It's because it's coming from cortisol from the adrenal cortex. Okay?
Questions on that? Okay, also if you have a lot of prednisone that's going to make your sugar go up too, right? You're just getting outside cortisol coming in. Okay? Alright, so this is just showing you different, on the other slide, different functions of cortisol.
Okay, so what if you have too much cortisol? Alright, well there's a disease called Cushing's Syndrome. What happens here, the most common cause, MCC's most common cause, is lung cancer.
Kind of an odd thing, but I kind of showed you this with ADH, and it's similar to here. There's certain lung cancers, four different types of lung cancers, and one of those types releases an ACTH-like hormone. So it looks like ACTH, but it's not, but it has the same P that would fit into the keyhole on the adrenal cortex to release aldosterone.
Does that make sense? So you have this imposter ACTH that's going to release cortisol and a certain type of lung cancer does that. Okay, other causes you have pituitary tumor.
that's going to release a lot of ACTH or also people on corticosteroid medication, prednisone, those kinds of things. When they're on it for a long amount of time, that's what happens. You only like to keep them on for like 10 days or so. You taper. on and taper it off.
One pill, one pill, two pills, two pills, four pills, and then it goes back down to three pills, two pills, one pill. It's kind of like this. It's a very strict regimen, which you'll learn about later, but that's why we're so concerned about that because of all the side effects that can happen when corticosteroids.
So symptoms of puke cushion syndrome. Alright, you'll have high glucose. We have hyperglycemia in the bloodstream.
So high glucose. You'll have high blood pressure, hypertension. You're going to have weight gain.
Because you have so much of this glucose that goes in there, it's not going to be used. So it needs to be put back into fat. Now this is a very distinct way of looking at these people because the fat accumulates more in the trunk and the back of the neck but the legs and the arms don't look fat. What happens with them is that you're going to have decreased protein synthesis. Meaning, in all the proteins that are in your muscles, right, actinomycin, right, good old days, those are proteins that are not going to be made.
So therefore your muscle thickness is going to get smaller. So the muscles in your legs get thinner. Does that make sense?
So these people kind of look like what I consider an egg, because all the fat is distributed towards the belly and the neck. So an egg walking on two sticks. See it?
Kind of looks like an egg here, but look how thin those legs are. See that? Alright?
That's why I can look at people. I have an idea of what's going on. I know you have, and I know you have.
But you get that, you can look at people and have an idea. Alright? See this, it's got this... And the face itself is what we call moon face. It's kind of a full face.
Round. Right? But look how thin those legs are.
This is striae. I don't want to get into that, but that's what we also look at on the skin striae. But we'll get into that.
They look like father and son, and they really aren't. that has that classic moon face, the fullness. They get this...
We call it a buffalo hump. But this hump that's over here, this is before the disease and you got this hump. Which is fat. Fat distribution.
This is someone with Cushing's disease and then she gets treated for it and you got this thinner face. Where I can look at people and say you're on corticosteroid. I have an idea. Right? Hmm.
Jerry Lewis, do you guys know who he is? I'm kind of skeptical, I always put him on here. If you were back in the 70s and 80s, you would know who he is. He's the one that really started the Muscular Dystrophy Association, the foundation of the telephone that happened on Labor Day. He was a very big comedian back in the 50s and 60s with Dean Martin.
That's besides the point. But what I want to show you is, this is what he looked one year, and the following year, he blew up like this. My parents are saying, geez, look at how much he's been eating. That's not, I can tell you right off the bat, that's not because of eating.
One, he doesn't eat that much in one year. And two, look at how round that face is. You see it? It's like that moon face.
I say he's on corticosteroids. I know he's on it. I don't know what he's for, but then I read about him because he had a certain lung disease, which we'll learn about later.
It's idiopathic fibrosis. And that was going to decrease the amount of fibroblasts doing their thing. Alright, so questions about cushions? Alright, don't look at people with that.
Now, if you have a deficiency, then we have something called Addison's disease. We have a decrease of cortisol. This means that you can't counteract stress.
Not a good thing. The bear is chasing you. You're not going to get enough glucose into your bloodstream to get the hell out of there.
Not a good thing. You're not going to be able to deal with stress. You almost get in a car accident.
How do you know where to move to? Right? How to swerve off.
You're not going to be able to do those things. Let alone if you have an infection, you're not going to be able to fight it properly. So what's going to happen here... Or actually you would fight it really well, it's not that. So the most common reason is an autoimmune disease.
For some reason, remember MCC is the most common cause, so whatever reason, your body is making antibodies to fight it. your body. In this case, your body's making antibodies to fight against the adrenal cortex, more specifically the zona fasciculatus, which is where the cortisol is coming from.
Why? We don't know why, but that's what's happening. Okay?
Or you, for some reason, you could have hyposecretion of ACTH from the pituitary. A stroke up there and now it's not producing that much ACTH. Okay?
It usually affects the whole adrenal cortex, but cortisol usually is the mostly is mostly affected. Okay, so you get a decrease of cortisol mainly, but you also get a decrease of aldosterone and androgen. And you can look at levels of levels of this to try and figure out, well, he has a decrease of not just cortisol, he has a decrease of aldosterone, and he has a decrease of androgen. So you get more of an idea of, it must be a little bit higher where this is, where the cause is, and we'll be holding this to a theory.
These are the things that happen. They're basically going to be the opposite, right? So you're going to have low levels of glucose. Right, you're not producing cortisol.
So you can't get all that sugar up to you, you have to just rely on glucosome. You'll have weight loss, muscle weakness. Alright?
You will get the decreased ability to tolerate stress. disease, surgery, because you're not reducing this cortisol. You have hypotension. You'll have hyponatremia, right? You can have low levels of sodium, but this is why it's life debilitating.
levels of potassium. Being able to pick this up very quickly and trying to fix it is what's going to be the best way to deal with this. You don't want that potassium to go high up there, she will have or he will have a cardiac arrest.
The other thing that we do notice, and we're not too sure why this actually happens in the whole thing, but they usually get this bronze color on their skin. relating to something to do with the melanocytes producing more melanin. But they give this bronze kind of color. So here you have someone coming into your office who has low blood pressure, is weak and tired, and being keen on this, you say, we've got to figure out what's going on, but notice you've got a tan. Where have you been lately?
Just in the house. Why does it look like you got this tan? Putting things together To make you a better clinician in your future classes, courses, and your careers. You see what I'm saying?
Put it all together. There's a lot of reasons for hypotension, but there's not many reasons why you have hypotension and you have this tan color. Does that make sense?
And you're saving that person's life by finding out what it is and then try correcting it so that potassium doesn't get that high. Okay? You all know who he is, right? Yeah.
He had Addison's disease. He had an autoimmune disease. Now none of this came out until many years after he died.
You don't want to have, even with our current president, our previous president, you don't want to know that they have a certain disease and the possibility that they're going to die in office. That's not going to be very lucrative for the country, let alone the world. So they actually made it known many years after he died what he had.
Okay, questions about that? Alright, androgens. We're almost done.
Androgens. They're the precursors of testosterone. From androgens, it's going to make testosterone. Testosterone also comes from the testicles, and a little bit actually from ovaries, which we'll get into later.
But mainly from testicles in males, but both men and women also get testosterone from the adrenal gland. So in the male adolescent, the teenager, this is when it comes out mainly during puberty. You get the secondary sexual characteristics, the body growth, deepening of the voice, that kind of stuff.
The adult male, very little comes out, because most of it comes out of the testosterone. But if the person gets castrated for whatever reason, the gonads need to come out, maybe cancer or whatever, then what's going to happen is the adrenal cortex is going to release more testosterone to withstand the male characteristics. Does that make sense?
Adult female, this gives the female the sexual drive, the libido. And androgens could also be converted to estrogen. Learn a little about this when we get to the reproductive system.
but androgens become testosterone then when there's too much testosterone not enough receptors all right males have much more testosterone receptors than females right you know that so once the testosterone receptors are all filled then the excess testosterone turns back or now transforms into estrogen So androgens definitely give you testosterone, but indirectly will also give you estrogen. So if a woman has her ovaries removed for cancer or whatever reason, the levels of testosterone go down, the levels of estrogen go down, but... They're not zero because we do have some estrogen that's coming out indirectly from the adrenal cortex. Is that clear? Okay.
All right, that's what I want to say with the adrenal cortex. Now, adrenal medulla, very brief about this. Alright, it's stimulated by the sympathetic nervous system.
This is all news from you from A&P 1, when we dealt with the autonomic nervous system. Alright, it's the fight or flight, right? Being chased by a bear. Should you fight the bear or should you flee? the bear right fight-or-flight syndrome and it's directly innervated by short preganglionic fibers remember that good old days right all right so it just comes right from the spinal cord right down there okay and it happens very very quickly It releases two hormones that are in the category called catecholamines.
It releases epinephrine and norepinephrine. In the UK we refer to it as adrenaline and noradrenaline. Same thing.
If you want to write it up like that, that's fine too. But that's how we came up with the word adrenal gland. So that's what happens over here.
And this is basically what norepinephrine and epinephrine do. We all learned about an A&P once, I don't want to go too much into that. It deals with stress, right?
Your blood pressure goes up, your blood flow goes up, that kind of stuff. Now one other thing I just want to say, when you have too much of it, there's a tumor that's called a pheochromocytoma. or easily said as Pheo.
When I hear about Pheo, that's what that is. And basically, it's a non-malignant, meaning non-invasive tumor. But that does not mean that it can cause problems.
We talked about the pituitary tumors that occur, and it's usually non-invasive. It doesn't go into, it's not malignant. It doesn't go into other organs, but it stays there.
Same thing with this Pheo. It stays there, but it can grow. So, the problem is... is as it grows it's going to produce a lot more of those hormones whatever that tumor is a part of.
So in this case the adrenal medulla is going to release a lot of epinephrine and norepinephrine. You could imagine what that's going to be like right? Think of being non-stressed for the rest of your life.
You'll get these massive headaches, you'll get severe hypertension and that could lead lead to a stroke and he could die from it. Easy way to do it, just remove it. Just remove that tumor.
It stays within there in case. In your other classes you'll learn more about what cancers are, the differences between benign and malignant. Basically, in a nutshell, malignant means it can metastasize, it can spread to other organs. A benign tumor says it stays in that area that can cause problems because it can produce a lot more of the secretions that that normally would do. Okay?
Now, histology of the adrenal gland. We don't have good slides of them, but I do want you to understand the concept of what this is. I'm going to show you some art therapy up here, and I'll give you some of the mods to help you along with this.
We have the adrenal gland and histology. We have the outside connective tissue that's going to hold the whole adrenal gland together. We call it the capsule.
It doesn't release anything. It's just holding everything together. And then you've got the adrenal cortex that releases.
three hormones from three different layers in there. The zone of glomerulosa, fasciculata, and reticularis. Then you've got the inner core that's going to be the adrenal medulla, and that's going to release epinephrine and norepinephrine. So let me get my little picture up here. Here's the...
that's our little kidney. Now I'm going to draw a picture of the adrenal gland that's going to be much bigger than what should be on scale, but I want you to see the different layers. Does that make sense? Okay, so we have the adrenal gland that's going to sit over here.
Again, it's much bigger, it's not this big. I want you to visualize what's going on. And we have a few things in there.
Okay, I'll leave this up here and Jordan will break these pictures up. So we have our adrenal gland. And we have layers here that you need to understand.
We have this outer layer that's called the capsule. And that's not going to release anything. Just connect the tissue just to hold the whole thing together. We also have, and I'm doing the easier ones first, we also have this inner one, the adrenal medulla. And how many hormones get released from there?
Two, right? What two? Epinephrine and norepinephrine.
Yep, epinephrine and norepinephrine. Alright, and that's going to be our... Adrenal window. Right?
Now we got three over here from the adrenal cortex. Outermost layer, innermost layer, I'm sorry, middlemost layer and innermost layer. Does that make sense how I'm doing it color-coded? This is going to be the zona glomerulosa.
This is zona fasciculata. And this is zona reticularis. Outer to inner. This is where most students get mixed up on.
So use your mnemonics. Girlfriends rule, guy friends rule, whatever you want to use. Actually we're going to learn something in urology with the kidney. There's something called the glomerular filtration rate.
You'll learn that later on, but whatever works best for you. Just so you get those in order. Now, we also need to know what each one releases.
This one is going to release what? Aldosterone. This one's going to release cortisol. This is going to release androgens.
You need to know which one comes out. Now, my little mnemonic on this, you've heard that saying, the deeper you go, the sweeter it is? Think of these three layers. We'll go to the outermost layer. Does that have to do with anything sweet?
What does that have to deal with? Salt, if anything, right? Aldosterone deals with sodium, potassium.
That's not sweet at all. So we go deeper. The deeper you go, the sweeter it is. Does cortisol have to do anything with sugar?
Yeah. Glucose, right? That's sweet.
Not as sweet as sex steroids. Alright? Right?
Sex, steroids, sweeter, right? So, the deeper you go, the sweeter it is. Does that help you?
Okay? Now, look what we did over here. I created a multiple choice question.
Look. From outer, we say that's A. B, C, D, E. You see the layers?
And I could say, if I had a picture of this on the test, which layer is going to release? Cortisol. C. Which layer is going to increase sodium into the bloodstream?
B, right? Which layer is known as zona reticularis? D.
All right. Do you see how this is all coming together and how to apply this kind of stuff? All right.
Questions on that? Alright, a little helpful stuff. Alright, I just got a few other things to say and I'm going to give you guys a break. Alright, so I was showing you before, right?
There's the capsule, zona glomerulosa, zona vesiculata, zona reticularis, and there's the medulla. That's what it would look like in a microscope slide. It's difficult with our microscope slides to visualize that.
So I'm not going to hold you to see it on a practical exam, but you do need to understand the concept of it for the lecture exam. Okay? And that's another way of looking at it too.
Alright? The training model, I'm not going to ask you what that looks like in there, but I'll just put it up there to be complete. Very briefly on these other organs, because we'll get more into them when we get into those areas like the reproductive system.
The ovaries, there's something called estradiol. That's the most abundant form of estrogen. Okay? And this is stimulated by FSH.
The estrogen will come from the follicles, which are little egg sacs in the ovaries. And once that egg pops out... The ovary, the area that had just popped out of the ovary is now a very crucial area and we call it a corpus luteum. That's going to also produce a lot more estrogen.
Female puberty, it helps with making the... It helps to... The lining of inside the uterus, it makes it more adaptive for the implantation of an embryo. We'll get into that later on. We have progesterone and progest...
Progesterone is coming out of the corpus luteum. It also comes from the placenta, as much as estrogen comes from there too. And it maintains the pregnancy. We also know that if you get high levels of progesterone, from outside the body, it's going to stop eggs from being ovulated, from popping out of the ovary. So we need to make sure that if you're going to have a birth control pill, that we need to make, we need to make sure that there's going to be progesterone in there because that's going to stop your body from ovulating.
Okay, more about that when we get to the reproductive system. We also have some other ones on there, inhibin and relaxin. To test these, testosterone comes out of there and that's going to maintain the male characteristics. We also have inhibin that comes out of there that's going to inhibit the FSH.
released more about that reproductive system. And then we have miscellaneous endocrine glands. The heart, as I mentioned before, does release a hormone, the AMH, which is going to inhibit aldosterone and it's going to indirectly or directly decrease blood pressure.
We also have a bunch of, well there's three specific ones we're going to go into with the gastrointestinal tract. There's ones that comes out of the stomach and then there's two that come out of the small intestine. We'll deal with those hormones when we get into the digestive system. As I mentioned before, it's also an endocrine gland that's going to produce a lot of other hormones which we'll get into, one called beta-HCG. and we actually use that the only place that beta-HCG comes out of is the placenta.
So, i.e., you've got to be pregnant for this to happen. This is what we test for with pregnancy tests to see if you have beta-HCG in your bloodstream. Kidneys also release hormones. We'll talk about erythropoietin increasing levels of red blood cells and also, as I mentioned before, renin is also another major one that you should know, but that's going to increase blood pressure.
Skin, we have a certain type of vitamin D that comes out that's going to increase calcium. And this is an interesting one. Adipose tissue, fat, releases a hormone called leptin.
Leptin comes out and it increases your hunger. So this is something they're doing research on, right? There's always new diet fads out there and stuff.
But think of what's happening here. The more fat you have in your body, the more leptin comes out of your body. Which means the more hungry you get.
Does that make sense? It's a big vicious cycle that goes on. The bigger you are, the more hunger you get for this reason. So they're trying to come up with research to say, alright, yes, you have a lot of adipose tissue. But we want to see if there's a medication we can give you that's going to inhibit leptin from coming out.
Even though you have a lot of adipose tissue there. So if they could do that, you're not going to get as hungry as much and you can lose the weight. So there's more research going on to that.
Okay? You see this slide before? Alright, it kind of breaks down at least the majority of the hormones, not all of them, but the majority of hormones and where they're coming from. And lastly, I'm not going to talk much more about thymus until we get to the immune system and a little bit of hematology. Ovaries and testicles we'll definitely get into when we get to reproductive, I don't want to spend any more time on that.
And we're not going to talk any more about the penile gland, melatonin, right? the circadian rhythm, the circadian cycles. Studying tips, it's not bad. I gave you a chart before.
Get yourself organized. This is not... a lot of students think it's a bad subject, but it's not because of understanding the material, but because of the overwhelming volume of all the different hormones and how they interfere, or they interact with other things.
So just get yourself, you know, if you want to... I use... flashcards.
I think flashcards are a wonderful thing. Charts, if you want to use that to organize yourself. Whatever works best for you.
There's a lot of players you need to know where they come from, where they go, where they target, and the function. If you understand that, then you understand if there's too much of it, what's going to happen. Too little of it, what's going to happen. The diseases are just given the normal stuff meaning.
When I talk about Kahn's disease or Addison's disease it's just making sure you understand understand what each one does. Okay? Questions on this?