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Adrenal hormones ch 26

Adrenal gland consists of cortex and medulla Adrenocorticosteroids as ( mineralocorticosteroids and (glucocorticosteroids Adrenal cortex is divided into 3 zones that syunthesize various steroids from cholesterol : and secrete them outer zone ( glomerulosa) which produces mineralocorticosteroids as aldosterone responsible for na and water retention. Production of aldosterone is regulated by rennin angotension system Middle zone( fasciculate) which produces glucocorticoids as cortisol which is anti stress. And maintains normal metabolism Inner zone (reticularis) which produces adrenal androgens as androsterone ( di hydro .(epiandrosterone Outer zone ( mineralocoryicoids) is controlled by pituitary corticotrophin .adrenocorticotrophic hormone

Glucocorticoids serve as feed back inhibitors .of corticotrophin secretion Hormones of adrenal cortex are used in Treating asthma Inflammatory disesase as rheumatoid arthritis Some allergic reactions .And some cancers ADRENOCORTICOSTEROIDS As glucocorticoids and mineralo corticoids They bind to specific receptors in target .tissues Glucocorticoids are widely distributed through out the body Mineralocoticods bind to excretory organs .as kidney, salivary glands and sweat glands Receptor hormone complex y3ni zy el cortisol lma ymsk m3a ay 7aga fl body mathalan ok is attached to gene promoter elements and turn genes on or off.( this (requires time

Whilewhile other glucocorticods effect cause relaxation of smooth muscles ( this must be immediate GLUCOCORTICOIDS Cortisol is the main principle human glucocorticoid produced in early morning and .in the evening .Factors such as stress affects its secretion (Actions of glucocorticoid aw ( cortisol :promote normal intermediary metabolism favor gluconeogensis by increasing amino acid re uptake by liver and kidney and elevate acivity of gluconeogenic enzyes , stimulating protein catabolism and increasing lipolysis and fat re destribution so increasing glucose y3ml hyperglycemia therefore glucocorticoid insufficiency decreses glucose causing hypoglycemia NB lipolysis results as consequence of glucocorticoid augmenting action of growth hormone on adipocytes

Increases resistance to stress by awl 7aga increasing glucose level increase energy that is needed to combat stress and vasoconstrictor effect on small vessels elevate blood pressure so decresing .severe stress associated eith hypotension Alter blood cells in plasma By decresing eusinophils, monocytes and lymphocytes, WBCS so causing increase liability to infection. and macrophages and by increasing haemoglobin, redbloodcells, , .platelets :Anti inflammatory action Inhibition of phospholipaseA2 which leads to inhibition of arachidonic acid which inhibits .prostaglandins Interference with mast cell which decreases histamine

Inhibition of lymphocytes and macrophages Affect other componets of endocrine system Inhibition of corticotrophin production by elevated levels of glucocorticoids then further inhibition of them and stimulating thyroid stimulating hormaone , increasing growth .hormone It stimulates gastric acid secretion and pepsin, ,so causing peptic ulcers It causes osteoprosis and bone loss by decresing calcium Cortisol is essential for normal glomerular .filtration On fats it causes lipolysis and fat redistribution It causes retardation in children growth.by decresing calcium It is protein catabolic causing muscle waisting. By decresing potassium

Increasing sodium and decreasing potassium and calcium Cns stimulation y3ml euphoria, behaviour .change, pshycosis and depression Uricosuric Antiallergy 3shn Modify the chemical nature of antigen Inhibit release of allergic mediators Inhibit antigen antibody reaction .Prevent granulation of mast cell Inhibit cytokine release and tumor necrosing factor It also decrease immunity so become liable to infection. As it decreses leucocytes, dec .eusinophis, and decreses antibody formation .By3ml hypertension and thinning of skin Eye by3ml inc glaucoma, inc intraocular .pressure. By3ml cataract Uses of cortisone

Anti inflammatory Antiallergy Bronchial asthma Anaphylactic shock Leukemia Anaemias Autoimmune diseases as systemic lupus and collagen disease Hepatitis Shock Hypercalcemia Gout Hypervitaminisos D .Cerebral and severe pulmonary edema Side effects Euphoria Pshycosis Cataract Glaucoma Git peptic ulcre HTN and HF Osteoprosis Bone rarefaction Increase of infection Hypokalemia

Teratogenicity ( moshkela fl baby w lazm (n3mlha abortion Acne formation Hairsutism Insomnia hyperglycemia Cortisone examples of drugs as prednisone Prednisolone (Dexamethasone ( long acting (Beclomethasone( short acting El7gat el 3ndaha steroid nucles as Sex hormaones Cortioco steroid Vit d Bile salt Bile pigment Difitalis chloesterol :Precautions If suffering from heart burn Every week measure body weight and .pressure

Every 6 month , make bone density and bone scan Every week urine glucose analysis Dietary intake by inc protein, dec .carbohydrate, dec fat Contraindications HTN HF Peptic ulcer Osteoprosis DM Pshycosis Infection Pregnancy Cushing syndrome :Mineralocorticoidss help to control body water and elecrolytes. Aldosterone acts on kidney tubules, causing reabsorption of sodium in git sweat and salivary glands , bicarbonate and water and .excretion of potassium and hydrogen

Hyper aldosterone causes alkalosis, hypokalemia, also sodium and water retention .caused by inc aldosterone onc blood pressure Antagonist of aldosterone is spironolactone Uses of adrenal corticosteroids Addison diseses ( replacement of primary (adrena cortico insufficiency Caused by adrenal cortex dysfunction. Lack of the patient to respond to corticotrophin Hydrocortisone is given twothirds in the .morning and one third in the afternoon Plus fludrocortisones which is a potent .glucocorticoid and mineralo corticoid Replacement for secondry and tertiary adrenocortical insufficiency These defeciences is due to defect in CRH formed by hypothalamus or by pituitary Mineralo corticoids is less impaired than glucocorticods .Hydrocortisone is used as a atreatment Diagnosis of cushing syndrome

Cushing syndrome is caused by hypersecretion of glucocorticoids from excessive release of corticotrophin by anterioir pituitary The dexthamethasone suppresiion test is used to diagnose the cause of cushind Synthetic glucocorticoid suppresses ( y2ll) corisol release only bs mlosh ay effect 3la glucocorticoids Dose lazm ttzbt y3ni elhigh doses mn synthetic glucocoticoid ghalat tzwd cushing .syndrome T Replacement therapy for congenital adrenal hyperplasia Results from enzyme defects in adrenal steroid hormaones Leads to virilization of hormaones in females due to over production of adrenal androgens Treatment requires sufficient cortico steroids to normalize hormaone levels by suppressing CRH and ACTH

Release of inflammatory symtomsas rheumatoid and osteo arthriris as wella as redness, swelling 3shn el3 reasons el2olnahom .abl kda Antiallergy by treating bronchial asthma, allergic rhinitis. Applied topically 3la respiratory tract ;Acceleration of lung maturation Respiratory distress syndrome is a probles in premature infants, fetal cortisol is a regulator of lung maturation.beclometahsone is administrated to the mother IM 48 hours prioir .to birth and 24 hours before delivery Pharmacokinetics and fate Synthetic glucocorticoids taken oral. Im, iv, .intra articular Metabolized by liver .,Products are produced by kidney

The only glucocorticoid has no effect on fetus is prednisone.v imp With drawl gradually to prevent adisonism .crisis

Inhibitors of adrenocorticoid .biosynthesis A7m wahd spirono lactone Antihypertensive drug inhibits sodium reabsorption in kidney, antagonize aldosterone, used to treat hairsutism, in women, adverse effects hyper kalemia, .gynecomastia, menusral irregularitires Metyrapone Used to test adrenal function treat pregnant womes with cushing syndrome. Interfere with gkucocorticoid syunthesis. Advers effects salt and water retention Aminoglutethimide

Inhibit conversion of chloeterol. Used to treat breast cancer and some malignancies Ketoconazole Antifungal agent, used tio treat cushing .syndrome Mife pristine Potent glucocorticoid antagonist .Used to treat patients with acth syndrome Eplerenone Avoid gynecomastia