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1、 The Adrenal Glands PartThe Adrenal medulla Part 1 Introduction Adrenal Glands Blood supply Nerve supplyAD Embryology of the adrenal gland Part 2 Adrenal medullaAt the interface between the neural and endocrine systemCase:Mrs.Smith,a 45-year-old woman Worried for panic attacks Sweating Palpitation S
2、udden 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()Adrenal medulla Composed of polygonal cells arranged in cords or cluster
3、 Numerous wide diameter capillaries Sympathetic ganglion Adrenal medulla chromate salt stain Brownish cytoplasm granules-when fixed by chromate salt containing fixative Also called chromaffin cell Hormones of adrenal medullaCatecholaminesAdrenalineNoradrenalineDopaminePeptidesOpiate peptidesAdrenome
4、dullinArginine vasopressinVasoactive intestinal peptide Catecholamine(CA)Synthesis of catecholamine Synthesis of catecholamine PNMT Regulated by glucocorticoids.Secretion of catecholamine Regulation of catecholamine secretion The activity of the adrenal medulla is regulated by the activity of the sy
5、mpathetic nerve.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 Actions of adrenal medullary hormones Fight and flight neuroendocrine response Emergency reaction hypothesis:W.B.Can
6、non,1928 Through activating adrenoceptors 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()Part 3 Disorders of the adrenal medullaPhaeoch
7、romocytoma:a tumor causes adrenal medullary hormones over-secretion PhaeochromocytomaSymptoms:with emergency reaction frequentlyDiagnosis (1)CT and MIBG:localization (2)Symptoms:HBP,HG,high BMR (3)VMA,AD and NA in urineTreatment (1)Operation (2)Adrenoceptor antagonists-adrenoreceptor blockers-adreno
8、receptor blockers Case:treatment(1)Drug treatment:-blockers-blockers(2)To find the source:CT and MIBG scan(3)Operation Familial Phaeochromocytoma Part 3 Pharmacological uses of adrenal medullary hormones Clinical uses of adrenaline1.Cardiac arrest2.Allergic shock:first choice3.Bronchial asthma4.Prol
9、ongation of local anesthetic duration5.Topical hemorrhage bronchial mucosa vessel dilation HA,SRS,PGs,BKAg-AbAllergized cellsBronchial SM contractiondyspneaIntrathoracic pressurereturned blood volumeSBPVessel dilationDBPmucosal edemaAD:first choice for allergic shock ADxxxxx Clinical uses of NA1.Shock and hypotension 2.Upper digestive tract hemorrhage Endocrine hypertensionBelongs to secondary hypertension:Conns syndromeCushings syndromePhaeochromocytoma
内分泌生殖系统教学课件：06 肾上腺髓质
