How To Cure Adrenal Fatigue

Adrenal Fatigue Recovery Workbook

This valuable book gives you all of the tools that you need in order to identify, manage, and treat the symptoms of adrenal fatigue syndrome. AFS is a medical problem that most doctors don't really know how to diagnose. The symptoms are often seen as being too vague to mean anything to medical professionals, and therefore people who suffer from this debilitating condition often suffer alone, and without medication. And those that DO get medicated often get put on something useless for this condition such as antidepressants or sleeping pills, which just add issues on to what you are already experiencing. If you are feeling down, tired, or depressed for no reason, there is a good chance that you are suffering from Adrenal Fatigue Syndrome There is no need for you to bear that alone! Why would you want to do that when you have a valuable resource in your hands? This book has everything you need to get help!

Adrenal Fatigue Recovery Workbook Summary


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Author: Jorden Immanuel
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Comments On Adrenal Gland

Metastatic carcinoma in the adrenal gland, particularly from lung, breast and kidney, is commoner than a primary neoplasm and usually detected by follow-up CT scan. Sometimes CT-guided needle core biopsy or FNA is used to make this distinction and more often primary adrenal neoplasms present either as a symptomatic or incidental mass or are characterized by their endo-crinological symptoms and signs and resultant biochemical profiles. Phaeochromocytoma is a contraindication to biopsy due to the risk of a catecholamine-induced hypertensive crisis. CT MRI scans can assess the size, characteristics and bilaterality of adrenal lesions, helping to distinguish hyperplasia (secondary to hyperpituitarism and usually bilateral) from neoplasm but are poor at designating benignity from malignancy apart from on the basis of size. Adrenal carcinoma cells are often dysfunctional and the tumour reaches a significant size (most are 5cm 50-100g) before presentation. Histologically the best indicators...

Plate 80 Adrenal Gland I

There are two adrenal glands, one at the upper pole of each kidney. The gland is a composite of two distinct structural and functional components a cortex and a medulla. The cortex develops from mesoderm and secretes steroid hormones the medulla develops from neuroectoderm of the neural crest and secretes catecholamines. Figure 1, adrenal gland, human, H&E x45. This low-magnification micrograph of a section through the partial thickness of an adrenal gland shows the outer capsule (Cap), the cortex (Cort) from one surface of the gland, the underlying medulla (Med), and a very small portion of the cortex from the other surface of the gland (Cort, bottom center). The cortex has a distinctly different appearance in both structural organization and staining characteristics. Figure 2, adrenal gland, human, H&E x180. Figure 3, adrenal gland, human, H&E x245. Figure 4, adrenal gland, human, H&E x245.

S adrenal glands

The adrenal glands are covered with a thick connective tissue capsule from which trabeculae extend into the parenchyma, carrying blood vessels and nerves. The secretory parenchymal tissue is organized into cortical and medullary regions (Fig 20.16) Embryologically, the cortical cells originate from mesodermal mesenchyme, whereas the medulla originates from neural crest cells that migrate into the developing gland (Fig. 20.17). Although embryologically distinct, the two portions of the adrenal gland are functionally related (see below). The parenchymal cells of the adrenal cortex are controlled, in part, by the anterior lobe of the pituitary gland and function in regulating metabolism and maintaining normal electrolyte balance (Table 20.9).

Neoplastic Conditions

Hepatocellular carcinoma often in background cirrhosis and serum AFP is elevated in 25-40 of cases. Single, diffuse or multifocal, bile stained and prone to venous invasion with metastases to lung, adrenal gland and bone. The commonest patterns are trabecular, plate-like or sinusoidal comprising variably differentiated hepatoid cells.

Lymph Node Metastases

Omental Caking

CT images showing unusual sites of metastic disease. Unusual sites of metastatic disease. A, Diffuse peritoneal infiltration with omental cake in a case of nonseminomatous germ cell tumor (NSGST). B, Bilateral adrenal gland involvement from relapsed semi-noma. C, Right psoas muscle metastasis from an NSGCT. D, Pleural disease from disseminated seminoma. Figure 6-7. CT images showing unusual sites of metastic disease. Unusual sites of metastatic disease. A, Diffuse peritoneal infiltration with omental cake in a case of nonseminomatous germ cell tumor (NSGST). B, Bilateral adrenal gland involvement from relapsed semi-noma. C, Right psoas muscle metastasis from an NSGCT. D, Pleural disease from disseminated seminoma.

Background And Relevant Pharmacokinetics

Lycopene is widely distributed in the human body and is one of the major carotenoids found in human serum (between 21 and 43 of total carotenoids). High concentrations are found in the adrenal gland and testes, although significant amounts are also found in the liver, adipose tissue, prostate, kidney and ovaries (El Sohemy et al 2002, Gerster 1997, Johnson 1998, Stahl et al 1992). Lycopene has also been detected in high concentrations in ciliary body and retinal pigment epithelium (Khachik et al 2002).

Cerebrospinal Fluid Marker Concentrations

Endodermal Sinus Tumor Cns

Metastatic yolk sac tumor. The patient is a 28-year-old man. In November 1998, he presented to another hospital with a leftside testicular mass 8 cm in diameter. He underwent orchiectomy, but details on histopathology, marker status, and postoperative therapy are not available. In November 2001, he presented to our medical center with cough and shortness of breath. Chest radiography demonstrated multiple pulmonary metastases and a mediastinal mass. A transbronchial biopsy specimen showed an undifferentiated malignancy consistent with yolk sac tumor, as well as elements suggestive of teratoma (A). The serum a-fetoprotein (AFP) concentration was 8,967 ng mL, the human chorionic gonadotropin level was 7 mIU mL, and lactate dehydrogenase was 197 U L. Computed tomography (CT) of the chest, abdomen, and pelvis confirmed the presence of bilateral lung metastases and a mediastinal mass and demonstrated metastases to the liver, spleen, and right adrenal gland (B and C). Magnetic...

Patterns Of Tumor Spread

Diagram Retrocrural Lymph Node

Other sites of bloodborne metastases include the brain, the liver, and bone. Metastases in unusual sites may be identified in patients with both seminomas and NSGCTs. Unusual sites of disease are most commonly seen in relapsed patients who have undergone previous treatment for metastatic disease. It is therefore important that the radiologist be aware of the patient's previous history and current clinical symptoms. Unusual sites include the kidneys, adrenal glands, muscles, spleen, prostate, pericardium, pleura, and peritoneum (Figure 6-7).16

And Parasympathetic Cardiac Controls

Heart Contractility Spread

The suprarenal glands can also contribute to vasomotion. Because norepinephrine is released directly into the bloodstream from these endocrine glands, arteriolar constriction in the systemic organs can result. The human fight-or-flight response elicited under stressful or exciting circumstances originates within the hypothalamus and via hormones travels to the pituitary gland and later the adrenal cortex, where the agent cortisol is released into the bloodstream and adrenal medulla. It is in the medulla that cortisol activates the enzyme necessary to convert norepinephrine to epinephrine, which is released into the bloodstream to amplify increased sympathetic activity (2,3). Blood flow to the skin and other internal organs (like the stomach and intestines) is greatly decreased by increasing sympathetic (and decreasing parasympathetic) tonic activity flow to skeletal muscles and the heart increases considerably. This process can be thought of as simply delivering blood to the areas of...

Endocrine System Anatomy And Physiology

Negative Feedback Mechanism Thyroid

Review textbook sections on the pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pancreas, and other endocrine glands. thyroid gland parathyroid glands adrenal glands adrenal medulla adrenal cortex pancreas pineal gland thymus gland ovaries testes Adrenal gland. To examine the adrenal tissue,

Transplantation and Tissue Rejection

Immune Suppressing Drugs For Transplants

Less drastic than an organ transplant is a cell implant, which consists of small pieces of tissue. Implants of liver cells may treat cirrhosis pancreas cells may treat diabetes skeletal muscle cells may replace heart muscle damaged in a heart attack or treat muscular dystrophy adrenal gland cells may treat Parkinson disease and brain cell implants may treat Alzheimer and Huntington diseases.

The Psychobiology Of Stress

Ship Breasting Dolphins

Production of CORT by the adrenal glands. Along with several other secretagogues, CRH regulates the production of adrenocorticotropic hormone (ACTH) by the anterior pituitary (for review, see Palkovits, 1987). Released into general circulation, ACTH binds to receptors on adrenocortical cells in the cortex of the adrenal glands and stimulates the biosynthesis and release of CORT into general circulation. Negative feedback regulates L-HPA activation and CORT production. Current evidence suggests that negative feedback is a widely distributed system involving CORT receptors in, but not limited to, the prefrontal cortex, hypothalamus, hippocampus, and the anterior pituitary gland (e.g., de Kloet, Vreugdenhil, Oitzl, & Joels, 1998 Sanchez, Young, Plotsky, & Insel, 2000).

Gnrh Enters Blood Vessels In

Round And Ovarian Ligaments

In a group of disorders called male pseudohermaphroditism, testes are usually present, but a block in testosterone synthesis prevents the fetus from developing male structures, and as a result, later, the child appears to be a girl. But at puberty, the adrenal glands begin to produce testosterone, as they normally do in any male. This leads to masculinization The voice deepens, and muscles build up into a masculine physique breasts do not develop, nor does menstruation occur. The clitoris may enlarge so greatly under the adrenal testosterone surge that it looks like a penis. Individuals with a form of this condition that is prevalent in the Dominican Republic are called guevedoces, which means penis at age 12.

Physical Activity Following Gunshot Wounds

Medical Photos Gunshot Wounds

As blood is lost, there is impaired perfusion of the tissue by blood with resultant cellular dysfunction (shock). The individual becomes anxious, weak, disoriented and restless. The pulse becomes weak, blood pressure falls, and breathing becomes rapid. The body initiates defensive mechanisms to counteract this loss of blood. Blood pressure (and thus tissue perfusion) is directly related to cardiac output and systemic vascular resistance (primarily the vasomotor tone of the blood vessels in the peripheral vascular system). As blood pressure falls, there is activation of the systemic nervous system. Epinephrine (adrenalin) and norepinephrine are released from the adrenals and sympathetic nerve endings. B1 receptors in the heart respond by increasing the heart rate and force of contraction. This results in an increase in cardiac output. Stimulation of A1 receptors in the peripheral vasculature causes selective vasoconstriction reducing the blood flow to the skin, gastrointestinal tract...

Pharmacological Toxicological Effects

Pseudohypericin has been shown to be a corticotropin-releasing factor (CRF)1 receptor antagonist. CRF has been implicated as a pathogenic factor in affective disorders, with elevated levels that are normalized after treatment with antidepressants found in the cerebrospinal fluid of patients with depression. CRF acts on CRF1 receptors in the pituitary gland to stimulate the release of adrenocoticotropic hormone, which stimulates the release of glu-cocorticoid stress hormones from the adrenal glands (19). It is possible that St. John's wort's activity comes from pseudohypericin's ability to block the CRF1 receptor.

The Mechanism Of Stress Reaction

3) the adrenal or suprarenal glands which are located one above each kidney and yield the steroid hormones and catecholamines. The hypothalamus receives signals from higher centres of the brain indicating a stress situation such stimulation causes release of chemical messengers called peptide neurohormones into the blood stream prompting the activation of the pituitary gland with the release of signals to the adrenal glands via the adrenocorticotrophin hormone (ACTH). Responding to ACTH stimulation the adrenal cortex, the outer area of the adrenal gland, secretes corticosteroids (glucocorticoids e.g. hydrocortisone or cortisol) which rapidly mobilise the body's carbohydrate, protein and fat reserves. In man hydrocortisone forms 95 per cent of the total glucosteroids formed in the adrenal cortex. Production and distribution of glucosteroid stress hormones is increased under stress although limited in the body at rest even when ginseng is administered. Ginseng encourages adrenal gland...

Multiplicity Of Human Sult Activities And Purification Studies

Initial studies of the heterogeneity of the human SULTs focused on two types of SULT activity, the high levels of hydroxysteroid sulfation in the human adrenal gland and multiple forms of phenol SULT activity in human platelets. The human adrenal is responsible for the high levels of dehydroepiandrosterone (DHEA) sulfate present in human fetal plasma. Micromolar concentrations of DHEA-sulfate in adult plasma are due to the synthesis and sulfation of DHEA in the reticular layer of the adrenal cortex (Parker, 1999). The synthesis of such large amounts of DHEA-sulfate in the adrenal gland is limited to humans and some higher primates (Parker, 1999). In humans, large amounts of DHEA-sulfate are synthesized and released by the fetal adrenal however, the fetal adrenal layer disappears shortly after birth and DHEA synthesis almost ceases. High levels of DHEA-sulfate synthesis begin again at adrenarche with the highest production in young adults. Adrenarche refers to the

Medicolegal Forms With Legal Analysis P-47

Heart Adrenals Weigh heart and measure thickness of ventricles. Dissect, weigh, and photograph both adrenal glands. Edema of lower extremities (absent in most uncomplicated cases). Changes reflecting high sodium and low potassium concentrations in the blood. Prominent left ventricular hypertrophy (1). Aldosterone-secreting adrenal cortical adenoma (Conn's syndrome), adrenal cortical nodular hyperplasia, or, rarely, adrenal carcinoma. Primary aldosteronism may be present in all these instances. Idiopathic aldosteronism is characterized by normal adrenal glands.

What Blood Vessel Empties Into The Interlobular Artery Is Called

Generalized Structure Blood Vessels

Adrenal gland Twelfth rib Adrenal gland Blood vessels associated with the kidneys and adrenal glands. Note their relationship with the renal pelvis and ureters. Blood vessels associated with the kidneys and adrenal glands. Note their relationship with the renal pelvis and ureters.

Glucocorticoid and Mineralocorticoid Receptors

Response, immune function, and mood (Tables 3.4, 3.5). Given the wide array of responses that these hormones (produced primarily by the adrenal gland) elicit, it is not surprising that the GR is expressed widely and that its function has been extensively explored. As discussed above (see Crosstalk Between Nuclear Receptors and Other Transcription Factors), analysis of bona fide target genes for GR has been complicated by the multiple mechanisms of transcriptional control that this receptor exhibits. For gluco-neogenic enzymes, the GR generally activates transcription through positively acting response elements. However, many of the actions of glu-cocorticoids are inhibitory, and this is partially achieved through binding to negative response elements within the promoters for genes such as prolactin and proopiomelanocortin. Most of the antiinflammatory effects of glucocorticoids involve another mechanism of repression, which does not seem to require the DBD of this receptor and...

Regulation of Cholesterol to Pregnenolone Conversion

Calcium as intracellular messengers.12 Steroid hormone biosynthesis in the adrenals is stimulated by the pituitary hormone corticotropin, which binds to its receptor at the cell surface and activates adenyl cyclase to increase intra-cellular cAMP. The latter compound serves as an intracellular messenger to transduce both the acute and the long-term effects of corticotropin. Following the conversion of cholesterol to pregnenolone by the mitochondrial side-chain cleavage system, the adrenals and gonads can transform pregnenolone to either progesterone or 17a-hydroxypregnenolone. The formation of progesterone from pregnenolone is catalyzed by the enzyme 3jS-hydroxysteroid oxidoreductase commonly referred to as 3j6-hydroxysteroid dehydrogenase (3jS-HSD) in combination with A5,4-iso-merase, in the presence of the cofactor (NAD + ). In addition, 3jS-HSD catalyzes the formation of other A4-3-ketosteroids from corresponding A5-3j6-hydroxysteroids, which leads to the formation of androgens,...

Conversion of Cholesterol to Pregnenolone

The first and rate-limiting step in the biosynthesis of steroid hormones in the adrenals and gonads is the conversion of cholesterol to preg-nenolone (Figs. 2.1, 2.2). This reaction occurs in the mitochondrion and is catalyzed by the cholesterol side-chain cleavage cytochrome P-450 (P450scc) enzyme (also referred to as cholesterol desmolase or cholesterol lyase) in conjunction with auxiliary electron-transferring proteins, located in the inner mitochondrial membrane. This electron-transport system consists of three protein components reduced nicotinamide adenine dinucleotide phosphate (NADPH)-de-pendent reductase (ferredoxin reductase), ferre-doxin, and cytochrome P-450. Electrons are Figure 2.2 Biosynthesis of steroid hormones in the adrenals. Figure 2.2 Biosynthesis of steroid hormones in the adrenals.

Reconnect to chapter 11 Sympathetic Division page 438

What Hormone Stimulates Adrenal Medulla

H Describe the location and structure of the adrenal glands. (a) An adrenal gland consists of an outer cortex and an inner medulla. (b) The cortex has three layers, or zones, of cells. (a) An adrenal gland consists of an outer cortex and an inner medulla. (b) The cortex has three layers, or zones, of cells.

Clinical Aspects

Glucocorticoids, the limbic system of the brain, the hypothalamus, the blood portal system connecting the hypothalamus with the anterior pituitary, and the adrenal gland are parts of the system. The normal values of steroidal hormones produced by the adrenal are presented in Table 10-2. When Cortisol is overproduced, often by a pituitary tumor causing high levels of circulating ACTH, the resulting disease is known as Cushing's disease. When Cortisol is underproduced, the resulting disease is known as Addison's disease, which is most frequently the result of adrenal destruction. The effects of Cushing's disease are summarized in Table 10-4. Hyperproduction of Cortisol from the adrenal gland would be expected to occur if there is a tumor of the adrenal producing abnormal amounts of the steroid or if there is a pituitary tumor producing high levels of ACTH (also if there is overproduction of CRH at the hypothalamic level, which apparently has not been documented so far). Adrenalectomy is...

Resection Specimens

Radical nephrectomy is the treatment of choice for patients with renal cell carcinoma (RCC). Radical nephrectomy encompasses ligating the renal artery and vein, removing the kidney outside the Gerota's fascia, the ipsilateral adrenal gland, and performing a complete regional lymphadenectomy from the crus of the diaphragm to the aortic bifurcation. The surgical approach includes either a transperitoneal incision (extended or bilateral subcostal and tho-racoabdominal) or an extraperitoneal incision, depending on the size and location of the tumour and the patient's condition. The surgical approach is guided more by individual preference than by necessity. Removal of the adrenal gland has been advocated because the gland is enclosed within Gerota's fascia and because ipsilateral adrenal metastasis occurs in 2-10 of most reported series. The risk of adrenal metastasis is related to the malignant potential of the primary tumour, its size and position. Patients with large tumours or tumours...

Solutions To Exercises Lesson

The suprarenal glands are embedded in the fat above the kidney on each side. Each suprarenal gland has an internal medulla and an external cortex. The inner portion produces a pair of hormones epinephrine (adrenalin) and norepinephrine (noradrenalin). These are involved in the mobilization of energy during the stress reaction ( fight or flight ). Each suprarenal cortex produces hormones which can be grouped into three different categories

Patterns Of Metastases

The lungs are the next most common site of spread of metastatic disease. This is often asymptomatic and found on routine imaging, but patients can present with symptoms of local pain or cough, or with haemoptysis and dyspnoea due to localized lesions, or, less commonly, with dyspnoea resulting from lymphangitis. Spread to other distant sites occurs less commonly, but as patients live longer following chemotherapy, bone, and, less frequently, brain, adrenals, skin, and other sites may be involved.

Chemistry And Biochemistry

Biochemistry Adrenal Glands

FIGURE 10-3 Development of the adrenal glands (A) at 5 weeks development of the human fetus (B) enlargement of the mesothelium (C) seventh week of development (D) secondary cortex (E) appearance of ganglionic cells (F) differentiation into chromaffin bodies in the late fetus. Reproduced from Langebartel, D. A. (1977). The Anatomical Primer, p. 443. University Park Press, Baltimore, Maryland. FIGURE 10-3 Development of the adrenal glands (A) at 5 weeks development of the human fetus (B) enlargement of the mesothelium (C) seventh week of development (D) secondary cortex (E) appearance of ganglionic cells (F) differentiation into chromaffin bodies in the late fetus. Reproduced from Langebartel, D. A. (1977). The Anatomical Primer, p. 443. University Park Press, Baltimore, Maryland. FIGURE 10-4 Schematic view of the circulation in a mammalian adrenal gland. The arteries and arterioles are shown in the capsule (cap), the outer layer of which has been removed. Other vessels shown are the...

Diagnosis and Staging

Rapid progress in the 1990s in laparoscopic surgery included the development of laparoscopic ultrasound probes. Laparoscopy provides the advantage of a visual inspection to exclude the presence of extrahepatic disease on the peritoneal surfaces in the abdominal cavity, and laparo-scopic ultrasonography can be performed on the liver and spleen and, in selected instances, on retroperitoneal structures such as the kidneys, adrenal glands, and pancreas. Laparoscopic evaluation and laparoscopic ultrasonography have further reduced the rate of unnecessary exploratory laparotomy and thus increased the proportion of patients who undergo successful hepatic resection at the time of laparotomy. Like intraoperative ultrasonography, laparoscopic ultrasonography reveals small primary or metastatic liver tumors not visualized on preoperative CT or MR imaging studies in up to 15 of patients.

Androgens And The Androgen Receptor

The testis, which produces testosterone, and adrenal glands, which produce androstenedione, dehydroepiandrostene, and dehydroepiandro-stene sulfate, contribute to the bulk of circulating androgens. These are converted in the prostate or peripherally by 5a-reductase to DHT, which is approximately 10 times more active than testosterone.13

Acute and Chronic Altitude Hypoxia

Increasing altitude is accompanied by decreased oxygen concentration. Studies on altitude natives and on sojourners at altitude have revealed the physiological and biological adaptations to short-term and long-term residency at high altitude that ensure adequate oxygen supply to tissues. Notable changes include altered ventilation rates, increased red blood cell number, and increased capillary volume. In recent years, the role of the autonomic nervous system in adaptation to altitude hypoxia has become apparent (181). Acute altitude exposure is associated with sympathetic activation and skin vasoconstriction. There is a blunted hypoxic pulmonary vasoconstriction response during the initial days of altitude exposure that has been shown to be independent of the NO cyclic GMP pathway (182). Chronic hypobaric hypoxia increases sympathetic activation and causes contraction of vascular smooth muscle leading to a rise in pressure in the pulmonary arterial circulation, and remodeling of the...

Atypical Nuclear Receptors

Several structurally divergent members of the NR superfamily have been isolated. The human gene DAX-1, which lacks a conventional zinc finger DBD, encodes one of these atypical NRs. DAX-1 contains a region consisting of four repeats of alanine and glycine-rich sequences that likely binds DNA. It is responsible for dosage-sensitive sex- and X-linked adrenal hypoplasia, an inherited disorder of adrenal gland development.68 The LBD of DAX-1 is similar to typical members of the NR superfamily.

The ENS is Derived from the Neural Crest

The restriction of the levels of the premigratory crest that contribute precursors to the ENS raises the possibility that the crest cells in these regions might be predetermined to migrate to the bowel and give rise to enteric neurons and or glia. Such a predestination, however, is not supported by experimental evidence, which indicates instead that premigratory crest cells are pluripotent. For example, when levels of the crest are interchanged so as to replace a region that normally colonizes the gut with one that does not, the heterotopic crest cells still migrate to the bowel and there give rise to neurons the pheno-types of which are ENS-appropriate, not level of origin-appropriate 62, 63 . An analogous process, moreover, is seen when the interchange of crest cells is reversed. Vagal and sacral crest cells give rise to non-enteric neurons in ectopic locations, such as sympathetic ganglia, when they are grafted so as to replace crest cells at other axial levels. Clones derived from...

Health Surveillance

Mice that die unexpectedly or spontaneously, or are identified through daily health screening in the quarantine or repository area as showing signs of poor health or disease, should be necropsied by a veterinary pathologist. This examination should consist of grossly visualizing major organ systems. This should be followed by a microscopic examination of all gross lesions within a subset of organs that include brain, heart, lungs, liver, kidney, adrenal glands, reproductive organs, gastrointestinal tract, pancreas, skin, and spleen. Where indicated, samples should be taken for microbial isolation, special diagnostic staining, or clinical chemistry determinations to aid in reaching a diagnosis. The lungs of immunodeficient mice can be silver stained and examined for Pneumocystis sp.

Ectopic Production Of Hormones By Tumor Cells

Various tumors have been shown to secrete ACTH and to cause hypercortisolism, even when the tumor is undetectably small for many years. The secretion of this hormone ectopically occurs mainly with bronchial carcinoid tumors and to a smaller degree with pheo-chromocytomas, thymic carcinoids, and islet cell tumors. The carcinoid tumors can be very difficult to locate. This condition can lead to Cushing's syndrome, characterized by overproduction of Cortisol from the adrenal gland as a result of the uncontrolled levels of ACTH or its stimulating hormone, CRH, derived directly from ectopic production of the hormone. These tumors can also secrete proopiomelanocortin-related peptides.

Microscopic Description

Sections from the heart revealed a recent apical-lateral myocardial infarction involving the papillary muscle. Remote infarcts in both anterior and posterior walls were also noted. Sections from the left circumflex showed plaque hemorrhage with associated inflammation. Significant findings in the lungs included moderate emphysematous change, early focal bronchopneumonia and intimal vascular proliferation consistent with pulmonary hypertension. The kidneys, adrenals, pancreas, intestines and bladder revealed diffuse hemorrhage in keeping with shock. The brain was remarkable for acute anoxic changes and multiple, old areas of encephalomalacia involving cerebellum, cortex and white matter.

Gross Description

Other significant autopsy findings included bilateral adrenal gland atrophy (combined weight 3 g, normal 8 g), small female genital organs, excessive epidural lipomatosis and severe osteopenia of the spine with multiple compression fractures in the thoracic and upper lumbar regions.

Postoperative management

Definition catechol-secreting tumors usually located in an adrenal gland. Most pheochromocytomas produce both norepinephrine and epinephrine. Endogenous catecholamine levels should return to normal levels within 1-3 days after successful removal of the tumor. Overall mortality 0-6 .

Physical Stress Reaction

Other types of physical stress such as immobilisation and positive radial acceleration stresses can similarly be effectively countered. Under such conditions ginsenosides restrict any major changes in the weights of the adrenals, thymus, spleen and thyroid as compared with control animals and modify blood sugar and liver glycogen changes.

Antihypertensive Renal Effects

The release of substance P, or whether PGE merely changes the properties of the nociceptor membrane, which results in increased firing. The elevated cyclic AMP, if involved, somehow produces pain, which, if persistent, results in a stress response via the hypothalamus (CRH) to release ACTH and then Cortisol from the adrenal gland. In addition to ACTH, (i-lipotropin is formed in equivalent amounts, which is processed to enkephalin via -endorphin, and enkephalin binds to a cell membrane receptor, which may compete with the PGE receptor in some way or produce a second messenger opposing the action of cyclic AMP.

S general structure of the kidney

The kidneys are large, reddish, bean-shaped organs located on either side of the spinal column in the retroperitoneal space of the posterior abdominal cavity. They extend from the 12th thoracic to the 3rd lumbar vertebrae, with the right kidney positioned slightly higher. Each kidney measures approximately 10 cm long X 6.5 cm wide (from concave to convex border) X 3 cm thick. On the upper pole of each kidney, embedded within the renal fascia and a thick protective layer of perirenal adipose tissue, lies an adrenal gland. The medial border of the kidney is concave and contains a deep vertical fissure, called the hilum, through which the renal vessels and nerves pass and through which the expanded, funnel-shaped origin of the ureter, called the renal pelvis, exits. A section through the kidney shows the relationship of these structures as they lie just within the hilum of the kidney in a space called the renal sinus (Fig. 19.1). Although not shown in the illustration, the space between...

Clinical Investigations

CT scan - the only cross-sectional imaging technique that adequately evaluates the lung parenchyma and is equivalent to MRI in the evaluation of mediastinum, pleura and chest wall. CT has a sensitivity of 80-94 compared with results obtained by mediastinoscopy and lymph node sampling. CT scans are used to stage carcinoma of bronchus and may be extended to include liver, adrenal glands and brain.

Other Orphan Receptors

Preliminary analysis of the activities and expression patterns of members of the large family of orphan receptors suggests that many are involved in the regulation of liver-specific metabolism (i.e., HNF-4, PPARa, LXR, FXR, LRH-1, SHP-1, SXR, CAR), while others seem to play roles in steroidogenesis, sexual differentiation, and germ cell development (i.e., TR2, TR4, SF-1, GCNF, NGFI-B, DAX-1) or neural function and specification (ERR, ROR, TLX, photoreceptor nuclear receptor PNR ) (Tables 3.8, 3.9). It is likely that these receptors integrate and regulate gene expression by virtue of regulation of the activities of some of the previously mentioned NRs. Several orphans (COUPs, RevErbA) seem to function exclusively as negative regulators of transcription, silencing in trans or bound to DNA as homodimers, RXR het-erodimers, and even monomers.3 At least one receptor (CAR) is a constitutive activator, whose activity is repressed in a ligand-dependent man-ner.322 Several structurally...

Causes and symptoms

At the same time nicotine is affecting the brain, it also stimulates the adrenal glands. The adrenal glands are small, pea-sized pieces of tissue located above each kidney. They produce several hormones, one of which is epi-nephrine, also called adrenaline. Under normal circumstances, adrenaline is released in response to stress or a perceived threat. It is sometimes called the fight or flight hormone, because it prepares the body for action. When adrenaline is released, blood pressure, heart rate, blood flow, and oxygen use increase. Glucose, a simple form of sugar used by the body, floods the body to provide extra energy to muscles. The overall effect of the release of these hormones is strain on the cardiovascular (heart and blood vessels) system. Stressed this way many

Pharmacological Toxicological Effects 51 Pharmacology

Although the effects of synephrine and C. aurantium differ slightly in hemodynamic studies, the relative content of synephrine compared to octopamine and tyramine (at least 100 times more synephrine) in C. aurantium products substantially outweighs the effects of octopamine and tyramine (18). Although synephrine is found endogenously in the adrenal glands (24), the function is still unclear (20). The binding of synephrine to various adrenergic receptors is shown in Table 2.

Hellevi Peltoketo Veli Isomaa Debashis Ghosh Pirkko Vihko

Estrogen and steroid metabolism in the target or surrounding cells therefore determine the availability of estrogens in breast tissue. The ovary is the single primary source of estradiol (E2) in the circulation of premenopausal women, but circulating estrone (E1) and androgens originating from the adrenal gland are also converted to E2 in peripheral tissues such as adipose tissue and muscles, including smooth muscle cells of the vena cava.15-18 Breast adipose and epithelial cells also contain enzymes needed for the production in situ of E2 from circulating precursors,7,16 which may further enhance estrogen action in the tissue. After menopause, in particular, estrogen biosynthesis in peripheral tissues has a major role in estrogen action.19 Finally, nutriment may contain compounds with estrogenic and or antiestrogenic effects.20

Infective Endocarditis

Infective endocarditis is frequently complicated by thrombocytopenia. These patients are also at risk for septic emboli manifesting as thrombotic or hemorrhagic stroke, myocardial infarction, renal infarction, or even acute limb ischemia (de Gennes et al., 1990). Thus, the profile of macrovascular thrombosis and thrombocy-topenia characteristic of HIT can be mimicked, especially as heparin is often used to anticoagulate patients with septic endocarditis (Delahaye et al., 1990). Micro-embolization leading to multiple small infarcts or microabscesses, in such organs as muscles, adrenal glands, and spleen, is an additional feature of endocarditis (Ting et al., 1990) that is not seen in HIT. When endocarditis-associated thrombocytope-nia is unusually severe, potential explanations include platelet-reactive autoantibo-dies (Arnold et al., 2004) or procoagulant monocyte-stimulating factors secreted by microorganisms from within large vegetations (Selleng et al., 2006).

Treatment of Early Stage Stage I Esophageal Cancer

Esophageal Cancer Stage Based Treatment

Noninvasive studies are quite helpful in identifying patients with meta-static disease. At presentation, 25 of patients with esophageal cancer have metastatic cancer. At autopsy, the most frequent locations of metastatic cancer, in decreasing order of incidence, are the lymph nodes (73 ), lung (52 ), liver (42 ), adrenal glands (20 ), bronchus (17 ), and bone (14 ) (Anderson and Lad, 1982). The presence of metastatic cancer is the worst prognostic factor in terms of long-term survival (Table 15-1). The median survival time of patients with metastatic esophageal cancer is less than 7 months. Because of this short survival, surgical resection is seldom performed, even for palliative purposes, in patients with metastat-ic cancer.

Comments On Retroperitoneum

The retroperitoneum contains the kidneys, adrenal glands, ureters, aorta, inferior vena cava, vessel tributaries, lymph nodes, nerve plexuses and autonomic ganglia. Due to its inaccessible anatomical location tumours can attain a considerable size before clinical presentation with vague symptomatology or because of pressure effects on adjacent structures, e.g. ureter. Investigation is by CT scan supplemented by ultrasound and MRI as appropriate. Arteriography may be used if resection of a large tumour is planned. Tissue diagnosis is by percutaneous CT-guided needle core biopsy or FNA. The commonest malignancy by far is periaortic lym-phadenopathy due to nodal malignant lymphoma (diffuse large B-cell or follicular lymphoma) or metastatic disease (testicular germ cell tumour, gut, prostate, renal, pancreatic or gynaecological cancer). The need for a tissue diagnosis is determined by the availability of previous data, the nature and stage of the disease process at which the...

Benchwork Preparation

Preparation of cadaveric kidney is essential to minimise haemostatic and other complications. The kidney is removed from its sterile container, placed in ice-cold sterile saline, and thoroughly inspected. The perinephric fat, muscle, lymphatics, and the adrenal gland are removed without injuring the renal vessels or the ureter. It is best not to dissect too close to hilum. Vessel branches that do not lead to or from the kidney are ligated. Arterial branches are completely

Cadaveric Donor Nephrectomy

Warm ischemic injury while the other organs are removed. The vena cava is carefully divided above the renal vein orifices, and the aorta is divided between the superior mesenteric artery and the renal artery orifices. After the liver has been removed, the ureters are divided in the pelvis and gently mobilised with a generous amount of peri-ureteral tissue to prevent injury to the delicate ureteral blood supply. The kidneys are mobilised from the retroperitoneum and removed en bloc with both adrenal glands. They are placed in basin with iced saline solution, and the left renal vein is separated with a cuff of vena cava. The aorta is divided in the midline, and the renal arteries are identified. Next, the anterior aorta is divided to separate the kidneys. The retroperitoneal adipose tissue is excised from the convex surface to exclude disease and assess the adequacy of perfusion. The kidneys are sterile. They are placed in preservative solutions and, then, packed in ice.

Frank Z Stanczyk Philip Bretsky

In the human body, a balance exists between production and clearance of steroid hormones. Production of steroid hormones occurs de novo by biosynthetic pathways in specific endocrine glands, i.e., the adrenals and ovaries in women and the adrenals and testes in men. In addition, steroid hormones can be produced in peripheral (nonendocrine gland) tissues from circulating precursors that originate from the endocrine glands. Important sites of peripheral steroid hormone formation include the liver, kidney, breast, prostate, and sexual and nonsexual skin. After steroid hormones are secreted by the endocrine glands, they enter the systemic circulation, where they are mostly bound to proteins. The low-affinity bound and non-protein-bound (free) steroids, sometimes referred to as bioavailable steroids, are available for binding to steroid hormone receptors (progestogen, androgen, estrogen, glucocorticoid, mineralocorticoid) and if active, they exert a biological effect. Alternatively, they...

T187m R227q F234l F194l

Several other androgen-signaling genes have been preliminarily studied in the context of prostate cancer risk. Testosterone is synthesized from cholesterol in a series of enzymatic steps involving several of the cytochrome P-450 enzymes.64 The enzyme cytochrome P-450c17 catalyzes two sequential reactions of the biosynthesis of T, in both the gonads and the adrenals. The first step is the conversion of pregnenolone to 17-hydroxypregnenolone (hydroxylase activity), and the second is its subsequent conversion to C19 steroid dehydroepiandrosterone (lyase activity), a steroid with androgenic activity.64 The CYP17 gene on chromosome 10 encodes the P-450c17 enzyme involved in these two sequential reactions in T biosynthesis.65 A T-to-C transition SNP exists in the 5'-UTR of the CYP17 gene (A2 allele).66 While the functional relevance of this polymorphism is in dispute, it has been linked to polycystic ovarian cancer risk in women, male pattern baldness in men,66 various estrogen metabolic...


The CYP11B isoenzymes are mitochondrial cytochrome P-450 enzymes. CYP11B1 is expressed at high levels and CYP11B2 at low levels in normal adrenal glands.70 The latter isoenzyme is dramatically increased in aldosterone-secreting tumors. In vitro studies show that both isoenzymes can convert DOC and 11-deoxycortisol to corticosterone and cortisol, respectively.

The Retroperitoneum

Celiac Trunk Divides Into

The body wall branches are segmental arteries in series with the posterior intercostal branches of the thoracic aorta.4 The inferior phrenic arteries supply the diaphragm and may send a branch to the adrenal gland. There are four pairs of lumbar arteries, which arise from the posterior abdominal aorta at the bodies of the four upper lumbar vertebrae. They pass laterally and posteriorly against the bodies of the vertebrae, posterior to the sympathetic trunk and posterior to the inferior vena cava on the right side as well.4 The anterior branches of the lumbar arteries are small and barely extend beyond the lateral border of the muscu-lus quadratus lumborum. Each artery also has a large posterior branch that accompanies the dorsal ramus of the corresponding spinal nerve and divides into spinal and muscular branches. The spinal branch passes through the intervertebral foramen and supplies the Branches of the abdominal aorta to paired viscera are the middle adrenal (suprarenal) arteries,...

Androgen Metabolism

The causes of hyperandrogenism are multiple (Table 12.1). Skin androgenization in women may be due to abnormal production of andro-gens by the ovaries and or the adrenal glands, and or to an excessive response of target cells in the pilosebaceous unit (peripheral androgen-ism) 6 . Androgens testosterone and the less potent androgens in women A4-androstenedione (A4A) and dehydroepiandrosterone (DHEA) are synthesized by the adrenals (mostly DHEA and its sulfate - SDHEA) and the ovaries (mostly A4A) and may be subsequently transformed into oestrogens through the aromatization of the molecules. Sex hormone binding globulin (SHBG) synthesized in the liver is the major carrier protein for androgens and oestradiol. Only free androgens, unbound to SHBG, are directly active on target cells. In tissues, androgens are first metabolically transformed into the active form dihydrotestosterone (DHT), which then binds to androgen receptors (AR) 16 .

Adrenal Surgery

Functional and non-functional adrenal disease forms a relatively small part of any endocrine surgery practice, with adrenalectomy accounting for less than 10 of the operative workload. Resection of the adrenal gland is ideally suited for a laparoscopic approach because open removal requires a relatively large incision for retrieval of a small gland, with greater morbidity and mortality as a result. Improvements in endoscopic instrumentation and technique has meant that most adrenal surgery can now be performed laparoscopically, the main criteria for an open approach being a tumour greater than 6 cm in diameter and the presence of malignant disease. The unit policy in fit patients is to remove any functioning adrenal tumour and any incidentaloma greater than 4 cm in diameter. There are a variety of approaches to the adrenal gland, either open or laparoscopic and via transperitoneal or retroperitoneal routes. The most common laparoscopic approach and the favoured route of the authors,...


Studies of the distribution of 3H ginsenoside Rg1 following intravenous injection have been performed in mice (80). Tissue radioactivity was greatest in the kidney, followed by the adrenal gland, liver, lungs, spleen, pancreas, heart, testes, and brain. Plasma protein binding was 24 , and tissue protein binding was 48 in the liver, 22 in testes, and 8 in the brain.


Cortical cells of the adrenal gland synthesize and secrete steroid hormones. They have abundant smooth endoplasmic reticulum (sER), mitochondria with tubular cristae, and lipid droplets, which are characteristic of all steroid-secreting cells. Laboratory Findings Used to Diagnose Adrenal Gland Disorders Laboratory Findings Used to Diagnose Adrenal Gland Disorders a. Characteristics. Pheochromocytoma occurs mainly in adults. It is generally found in the region of the adrenal gland but also is found in extra-adrenal sites. Figure 23-3. (A) Hyperplasia of the adrenal cortex as might be found in Cushing syndrome. (B) Normal adrenal gland showing the normal thickness of the adrenal cortex. (C) Hypoplasia of the adrenal cortex as might be found in Addison disease. All photomicrographs are taken at the same magnification so that the normal and pathologic changes may be compared. C adrenal cortex M adrenal medulla.


Neuroblastoma a paediatric tumour (80 occur 4 years of age) of the sympathetic nervous system belonging to the family of small, round, blue cell tumours. Most present with an intraabdominal mass. Forty per cent arise in the adrenal glands, most of the remainder being retroperitoneal or intrathoracic. Ganglioneuroblastoma and ganglioneuroma represent better-differentiated counterparts which are seen in an older age group and less commonly involve the adrenal gland. The clinical and laboratory aspects of these highly specialised paediatric tumours will not be discussed further. Other malignant neoplasms sarcomas (most commonly leiomyosarcoma) are very rare in the adrenal gland malignant melanoma and malignant lymphoma leukaemia usually secondarily involve the adrenals but may rarely be primary metastatic carcinoma is the commonest pathological lesion and can closely mimic primary adrenal carcinoma (lung, breast and kidney most common primary sites).

Urinary System

Linea Brodel

The kidneys are retroperitoneal organs that lie on the ventral surface of the quadratus lumborum muscle and lateral to the psoas muscle and vertebral column. The upper pole of the left kidney is located at vertebral level T12 and is related to the 11th and 12th ribs, the pancreas, the spleen, and the splenic flexure of the colon. The upper pole of the right kidney is located at vertebral level LI and is related to the 12th rib, the liver, the duodenum, and the hepatic flexure of the colon. The right kidney is lower than the left kidney because the liver is located on the right side. The kidneys are covered directly by a fibrous capsule (renal, or true, capsule) that can be stripped readily from the surface of the kidney, except in some pathologic conditions that cause strong adherence because of scarring. The kidneys are further surrounded by the perirenal fascia of Gerota (false capsule), which is important in staging renal cell carcinoma. The perirenal fascia of...


Barium Meal

AB Abdominal aorta AG Adrenal gland AZ Azygous vein BS Body of stomach C Sacral spinal cord CA Celiac artery Figure 9-4. Cross-section and CT scan at approximately vertebral level T12, where the portal triad is located. (A) Schematic diagram showing where the cross-section was taken. (B) Cross-section through a cadaver. (C) CT scan. Note the various structures indicated by the key. In addition, note the psoas major and quadratus lumborum muscles along the sides of the vertebral body. The right and left lobes of the liver are shown in relation to the portal vein, common hepatic artery, and inferior vena cava. The right adrenal gland lies posterolateral to the inferior vena cava. The left adrenal gland lies between the body of the stomach and the abdominal aorta. (Reprinted with permission from Barrett CP, Anderson LD, Holder LE, et al Primer of Sectional Anatomy With MR and CT Correlation, 2nd ed. Baltimore, Williams & Wilkins, 1994, pp 75, 76.) AG Adrenal gland Figure 9-5....

Cardiac Denervation

Cardiac Enurvation

Cardiac denervation results in a blunting of the chronotropic response to exercise. With exercise, heart rate increases because of an increase in plasma catecholamines (released primarily from the adrenal glands) rather than from direct sympathetic stimulation of the sinus node. Thus, heart rate increase is delayed the heart rate peaks well after cessation of exertion and remains elevated until the circulating catecholamines can be metabolized (Fig. 8).

Adrenal Tumors

Fatty Tumor Adrenal Gland

Gill Bates (45) is being worked up by his general practitioner for persistent decreased appetite and a slightly elevated erythrocyte sedimentation rate. Today he is booked for an abdominal CT. He is a little nervous, but Paul reassures him, while giving him a big cup of dilute oral contrast that will fill the lumen of the stomach and the small and large intestine. An intravenous cannula is inserted before the investigation. Contrast is injected after an initial unenhanced CT scan to better evaluate blood vessels and parenchymal organs of the abdomen. Paul looks through the CT images and discovers an abnormal-appearing adrenal gland (Fig. 10.19). f The adrenal glands have a Y or V configuration with a i thickness of5-8 mm. As a rule of thumb, the width should not exceed that of the adjacent crus of the diaphragm. Fig.10.20a The arrow points to a homogeneous well-circumscribed adrenal mass of about 2 cm in diameter and of low density. This is a textbook case of an adenoma. b In this...

Steroid Hormones

Steroid Hormones Cells

Steroid hormones are soluble in the lipids that make up the bulk of cell membranes. For this reason, steroid hormones can easily diffuse into their target cells. Once inside a target cell, steroid hormones combine (usually within the nucleus) with specific protein receptors. The resulting hormone-receptor complex binds within the nucleus to a particular region of the DNA and activates specific genes. The activated genes, in turn, are transcribed into messenger RNA (mRNA), which enters the cytoplasm where it directs synthesis of specific proteins. These proteins bring about the cellular changes associated with the particular hormone (fig. 13.4, table 13.3, and Clinical Application 13.1). An example is the steroid hormone aldosterone (al'do-ster-on , al-dos'ter-on), from the adrenal gland, whose action is to stimulate sodium retention by the kidneys. In response to aldosterone, cells that form tubules within the kidney begin to synthesize more Na+ K+ pumps, the proteins that actively

Figure 2023

Photomicrographs of a human fetal adrenal gland, a. Low-power micrograph of a H&E-strained section of a fetal adrenal gland. The permanent cortex (PC) is indicated in the upper portion of the micrograph. Below is the fetal zone (FZ) in which the cells are arranged in anastomosing linear cords. Some of the capillaries (C) are engorged with red blood cells, thereby making them more apparent. xlOO. b. Higher-power micrograph of the same specimen showing the capsule (Cap) and the underlying permanent cortex. The cells are arranged

Figure 2017

Hip Joint Labelled

In this early stage, the cortex is shown developing from cells of the intermediate mesoderm, and the medulla is shown differentiating from cells in the neural crest and migrating from the neighboring sympathetic ganglion. Note that the gland develops between the root of the dorsal mesentery of the primitive gut and the developing urogenital ridges, b. Mesodermal cells from the fetal cortex surround the cells of the developing medulla, c. At this stage (about 7 months of development), the fetal cortex occupies about 70 of the cortex. The permanent cortex develops outside the fetal cortex, d. The fully developed adrenal cortex is visible at the age of 4 months. The permanent cortex replaces the fetal cortex, which at this age has completely disappeared. Note the fully developed zonation of the permanent cortex. The central portion of the adrenal gland, the medulla, is composed of a parenchyma of large, pale-staining epithelioid cells called...


There are three general causative factors that may lead to the development of hypertension (a) primary aldosteronism, which results in the unrestrained production of aldosterone by the adrenals (see Chapter 10) (b) a pheochromocytoma, which is a tumor that produces catecholamines (see Chapter 11) and (c) renovascular hypertension, which results in a lowered blood supply to one kidney with normal blood flow to the second kidney.

Figure 2021

Photomicrographs of the cortex and medulla of the human adrenal gland, a. This photomicrograph shows a H&E-stained specimen of the outer cortex, it includes the connective tissue capsule, the zona glomerulosa, and the zona fasciculata. Continuous with the zona glomerulosa are the straight cords of cells that characterize the zona fasciculata. Between the cords are the capillaries and the less numerous arterioles. The red linear stripes represent capillaries that are en

Necropsy Procedure

Adrenals Aorta The following organs will be weighed prior to partitioning and fixation brain, heart, lungs, liver, kidneys, spleen, uterus, gonads, and adrenal gland. The pituitary will be weighed postfixation, and paired organs will be weighed separately. Organ to body weight percentages and organ to brain weight ratios will be calculated. The intestinal tract will be collected and the cecum separated from the colon. Intestinal specimens will be gently inflated with fixative by intraluminal injection and prepared as an intestinal roll (by placing it on an index card and rolling it in a flat spiral around a central toothpick). Care must be taken when collecting the pancreas, as it is firmly adhered to both the small and large intestine. The stomach is removed and also inflated with fixative. The liver should be the last abdominal organ removed. One should enter the thorax so as to use the diaphragm as a handle while the liver is removed. Upon removal of the liver, the salivary glands...


Although pathways of steroid hormone biosynthesis in the adrenals, ovaries, and testes have been known for a number of years, recently only have we begun to understand how genes control the enzymes associated with these pathways. Even less is known about how genes control the enzymatic steps involved in steroid metabolism. This is due to the fact that there are so many metabolites formed, as evident in the discussion on estrogens. Large interindividual differences exist in the metabolism of steroid hormones, which may be reflected in interindividual differences in estrogen action. The formation of so many metabolites raises the question of why it is necessary for the human body to form all of these metabolites. The usual answer to this question is that it is nature's way of detoxifying potent biologically active hormones. However, the metabolites might have important but unrecognized biological effects that are necessary for the action of some hormones. A clearer picture of the...

Figure 2019

Diagram illustrating the organization of the cells within the adrenal gland and their relationship to the blood vessels. Refer to Figure 20.18 for identification of the blood vessels. The ultrastructural features of the basic cell types and their secretions are noted. (Modified from Warwick R, Williams PL, eds. Gray's Anatomy. 35th ed. Edinburgh Churchill Livingstone, 1973.)

Clinical Application

Bile Duct Small Intestines

Kennedy's beautiful bronze complexion may have resulted not from sunbathing, but from a disorder of the adrenal glands. When he ran for the presidency in 1960, Kennedy knew he had Addison disease, but his staff kept his secret, for fear it would affect his career. Kennedy had almost no adrenal tissue, but was able to function by receiving mineralocorti-coids and glucocorticoids, the standard treatment. Treatment of Cushing syndrome attempts to reduce ACTH secretion. This may entail removing a tumor in the pituitary gland or partially or completely removing the adrenal glands.

And Disease

The overexpression of EPO occurs in a number of adaptive and pathologic conditions. In response to acute hypoxic stress, such as severe blood loss or severe anemia, EPO production can increase 100- to 1000-fold, although the maximal bone marrow response to such stimulation is only a 4- to 6-fold increase in RBC production (46). Overproduction of EPO with accompanying erythrocytosis may be an adaptive response to conditions that produce chronic tissue hypoxia, such as living at high altitude, chronic respiratory diseases, cyanotic heart disease, sleep apnea, smoking, localized renal hypoxia, or hemoglobinopathies with increased oxygen affinity (21). Paraneoplastic production of EPO from tumors and cysts, including renal carcinomas, benign renal tumors, Wilms' tumors, hepatomas, liver carcinomas, cerebellar hemangioblastomas, adrenal gland tumors, and leiomyomas, can also result in high plasma concentrations of the hormone.


Brown adipose tissue is also present in nonhibernating animals and again serves as a source of heat. In humans, multilocular adipose tissue is present in large amounts in the newborn, which helps offset the extensive heat loss that results from the newborn's high surface-to-mass ratio. The amount of brown adipose tissue gradually decreases as the body grows, but it remains widely distributed throughout the first decade of life. It then disappears from most sites except for regions around the kidney, adrenal glands, aorta, and regions in the neck and mediastinum. As in the mobilization of lipid in white adipose tissue, lipid is mobilized and heat is generated by multi-

HSD3B1 and HSD3B2

The enzyme 3 -hydroxysteroid dehydrogen-ase is a critical component of the androgen-me-tabolism pathway because it catalyzes andros-tendione production in steroidogenic tissues and converts active DHT into inactive metabolites in steroid target tissues. The HSD3B gene family has two genes and five pseudogenes, all of which map to chromosome 1p13.92-94 The HSD3B1 gene encodes the type I enzyme, which is exclusively expressed in the placenta and peripheral tissues, such as prostate, breast, and skin. The HSD3B2 gene encodes the type II enzyme, which is predominantly expressed in classical steroidogenic tissues, namely, the adrenals, testis, and ovary.93,95-98 A number of mutations in HSD3B2 have been found to cause congenital adrenal hyperplasia, a rare mendelian disease manifested by salt wasting and incomplete mas-culinization in males.99

Clinical Biology

The natural clinical history of prostate cancer is long, with projected transition from the first malignant cell in the prostate to distant metasta-tic disease taking more than 15 years in some cases and not occurring within the life span of a significant proportion of men.7 Important points at which the clinical course of the disease appears to accelerate include the development of metastases and the onset of resistance to primary hormone therapy. Local extension from primary prostate cancer may involve the bladder and seminal vesicles. This tumor also metastasizes through lymphatics to regional lymph nodes in the pelvis.8 Distant metastases commonly involve bone, especially the spine, but may involve distant lymph nodes and visceral organs, including the lung, liver, and adrenal glands.9

Figure 2022

The secretion and production of glucocorticoids and sex steroids by the zona fasciculata is under feedback control of the CRH-ACTH system. ACTH is necessary for cell growth and maintenance and also stimulates steroid synthesis and increases blood flow through the adrenal gland. Exogenous ACTH maintains the structure and function of the zona fasciculata after hypophysectomy. In animals, administration of ACTH causes hypertrophy of the zona fasciculata.

Figure 2016

Photomicrograph of the adrenal gland. This low-power micrograph of a H&E-stained specimen shows the full thickness of the adrenal gland with the cortex seen on both surfaces and a central region containing the medulla. Within the medulla are profiles of the central vein. Note that the deeper portion of the cortex stains darker than the outer portion, a reflection of the washed-out lipid in the zona glomerulosa and outer region of the zona fasciculata. This section also includes a cross section of the adrenal vein, which is characterized by the longitudinally arranged bundles of smooth muscle in its wall. x20.


The initial spread of most germ cell tumors occurs to the lumbar para-aortic lymph nodes via the testic-ular lymphatics. Less frequently, direct lymphatic communication or hematogenous spread can occur, resulting in metastases to diverse areas. Two postmortem studies, one of 78 and the other of 154 patients with histologically confirmed germ cell tumors, found that metastatic disease often followed predictable patterns. In order of decreasing frequency, sites of metastases commonly reported were lungs (90 ), retroperitoneal lymph nodes (80 ), liver (70 ), mediastinal lymph nodes (65 ), brain (30 ), kidney (30 ), gastrointestinal tract (27 ), bone (20-30 ), adrenals (20-30 ), peritoneum (20 ), and spleen (10-20 ).1112 Less frequent sites of metastases include the pancreas, pleura, heart, pericardium, and vena cava.1112 The diaphragm, thyroid, breasts, eyes, skin, and spinal cord are rare reported locations for germ cell tumor spread.1112 Despite the great impact of platinum-containing...


Deficiency of thyroid hormone or hormones from the adrenal gland is well recognized as a cause of depression. However, most patients with depression do not have conventional endocrine abnormalities. More subtle changes in hormones have nevertheless been proposed as the cause of depression, as in the response to stress of the adrenal gland. However, these have not so far led to major advances in treatment or understanding of the condition.

Box 205

Fetal Adrenal Gland The fetal adrenal gland consists of an outer narrow permanent cortex and an inner thick fetal cortex or fetal zone Once fully established, the fetal adrenal gland is unusual in terms of its organization and its large size relative to other developing organs. The gland arises from mesodermal cells located between the root of the mesentery and the developing gonad zone (see Fig. 20.17a). The mesodermal cells penetrate the underlying mesenchyme and give rise to a large eosinophilic cell mass that will become the functional fetal cortex or zone (see Fig. 20.17b). Later, a second wave of cells proliferates from the mesenchyme and surrounds the primary cell mass (see Fig. 20.17c). By the fourth fetal month, the adrenal gland reaches its maximum mass in terms of body weight and is only slightly smaller than the adjacent kidney. At term, the adrenal glands are equivalent in size and weight to those of the adult and produce 100 to 200 rng of steroid compounds per day, about...

Adrenal Infarction

The adrenal gland contains a plexus of small veins and venules which receive the secreted hormones of the adrenal gland. This venous structure appears prone to thrombosis in several hypercoagulable states. Patients with purpura fulminans may present with adrenal crisis due to thrombosis and the resultant hemorrhagic destruction of the gland. Patients with heparin- induced thrombocytopenia may rarely infarct the gland and have subsequent hemorrhage. Finally, patients with antiphospholipid antibody syndrome can have adrenal infarctions. The presentation in APLA patients is often one of adrenal insufficiency that initially may be overlooked due to nonspecific symptoms.

Dax1 Shp1

Phenotypes of homozygous null mutations of the indicated mouse receptor genes are summarized where available, as are expression patterns for individual receptor genes. NGFI-B, nerve growth factor induced receptor B Nurr1, Nur related receptor 1 NOR, neuron derived orphan receptor COUP-TF, chicken ovalbumin upstream promoter transcription factor HNF4, hepatocyte nuclear factor 4 TR2 TR4, testis receptor 2, 4 GCNF, germ cell nuclear factor SF-1, steroidogenic factor 1 FTZ-F1, fushi tarazu factor 1 LRH1, liver receptor homolgous protein 1 ERR, estrogen related receptor ROR, retinoic acid related orphan receptor TLX, tailless related receptor X DAX-1, dosage sensitive sex reversal adrenal hypoplasia X chromosome region 1 SHP, small heterodimer partner AG, adrenal gland, THY, thymus PHN, paraventricular hypothalamic neuron CNS, central nervous system H, heart L, liver, LU, lung K, kidney I, intestine TS, testis OV, ovary G, gonads LY, lymph B, bone EMC, extraskeletal myxoid chondrosarcoma...

Orexin System

As expected for receptors that coordinate complex feeding behavior, an extensive network of projections extends throughout the CNS. Transcriptional profiling and immunohistochemical staining79 indicate that OXA is expressed in the periphery, including ganglia and endocrine cells in the kidney, adrenals, stomach, and intestine. In the pancreas, the majority of cells that are insulin positive also express OXA. OX1R is selective for OXA and appears to explain the preponderant data implicating the orexins in feeding behavior. Accumulating data from animal models8182 confirm that the OXA ligand stimulates appetite, but experimental outcomes have been found to vary, depending upon site and time of delivery. Xu and co-workers83 suggest that apparent inconsistencies could derive from responsiveness of the orexin system to circadian rhythm and its involvement in determining wakefulness and, thereby, activity levels. Whereas the hypophagia observed in orexin ligand-knockout mice84 supports a...

Deletion 7q

McMorrow and colleagues reported an infant with bilateral anophthalmia and other malformations associated with an interstitial deletion of the long arm of chromosome 7 from the q21.1 to q36.1 bands.224 Absence of the adrenal glands has been reported in monosomy q1 and q3 (distal deletions).

Ghsr Expression

The expression patterns of the type 1a and type 1b GHS-Rs were studied by ribonu-clease protection analysis in human and rat tissues and by in situ hybridization histochemistry in rhesus hypothalamus and rat brain and pituitary. Functional assessment of sucrose gradient-fractionated poly (A)+ mRNA from swine pituitary gave a single peak of GHS-R activity in the size range 1.6-2.3 kb (Fig. 7). However, attempts at detecting GHS-R mRNA by Northern blotting analysis have been unsuccessful, even though control mRNAs for other GPC-Rs could easily be detected. The authors attribute the difficulty in detecting GHS-R mRNA by Northern blotting analysis to its low abundance and potential size heterogeneity. TRH and GnRH receptors were also readily detected functionally. PCR amplification of the swine pituitary GHS-R cDNA sequences from among 11 pools of an unamplified pituitary cDNA library (110,000 individual cDNAs pool) resulted in GHS-R cDNA identification in only 4 of 11 pools. Therefore,...


Glucocorticosteroids have activity against prostate cancer. Their use as sole therapy is limited by long-term side effects including proximal myopathy, osteoporosis, and diabetes mellitus. While one study suggests they are as efficacious as flutamide in patients failing castration,140 in practice glucocorticosteroids are most often used as an adjunct to other therapy, such as aminoglutethimide or mitoxantrone. When used with aminoglutethimide, their primary role is to compensate for suppression of essential gluco-corticoid production by the adrenals.