Adrenal Exhaustion Recovery
ADRENAL GLAND. adrenal gland One of two endocrine glands located on the top of the kidneys each consists of an adrenal cortex, which secretes cortisol and aldosterone, and an adrenal medulla, which secretes epinephrine and norepinephrine adrenal insufficiency Abnormally low or decreased production of adrenal corticoid hormone by the adrenal gland. addison's disease is the result.
Angiotensinogen (renin substrate) is a 60-kDa polypeptide released from the liver and cleaved in the circulation by renin to form the biologically inactive decapeptide angiotensin I. This is in turn cleaved to form active angiotensin II by angiotensin converting enzyme (ACE). Angiotensin II causes contraction of vascular smooth muscle, and thus raises blood pressure and stimulates aldosterone release from the adrenal glands. Angiotensin is finally broken down by angiotensinases.
In this patient, MTC became evident as a unilateral thyroid mass with local lymph node involvement. The key diagnostic tests at the time of presentation were tests for pheochromocytoma and hyperparathyroidism so that the probability of a MEN syndrome could be assessed. This approach is important for two reasons (1) surgical removal of a thyroid mass in a patient with untreated pheochromocytoma is risky and potentially fatal and (2) if the patient has a familial form of MEN, evaluation of asymptomatic relatives is central to their early diagnosis and cure. Normocalcemia in this patient tended to rule out concurrent hyperparathyroidism, and normal urinary catecholamine values suggested absence of pheochromocytoma. Some physicians recommend computed axial tomography of the adrenal glands for additional evidence of absence of pheochro-mocytoma. The familial connection for this patient was impossible to pursue by evaluating the family history, since she was an adopted child and knew of no...
Atrial natriuretic peptide ANP A polypetide hormone found mainly in the atrium of the heart of many species of vertebrates. It is released in response to atrial stretching and thus to elevated blood pressure. ANP acts to reduce blood pressure through stimulating the rapid excretion of sodium and water in the kidneys (reducing blood volume), by relaxing vascular smooth muscle (causing vasodilation) and through actions on the brain and adrenal glands.
Genetic testing ruled out the presence of the hybrid gene abnormality responsible for the rare, glucocorticoid-remediable form of inherited PAL. Computed tomography (CT) scanning of the adrenal glands, using fine (2.5-mm) cuts before and after intravenous contrast enhancement, showed mild thickening of both glands, but with no obvious mass lesions. Comparison of adrenal with peripheral venous aldosterone cortisol ratios (rightmost column) revealed definite production of aldosterone by the right adrenal gland, but suppression of aldosterone production by the left, consistent with right adrenal APA.
Cortisol A glucocorticoid hormone secreted by the adrenal gland to moderate stress. Among other things, glucocorticoids promote the breakdown of protein stores in the body to produce sugar (glucose) and can decrease immune system activity. Cortisol levels are high in people with HIV infections, and the hormone has been implicated in wasting syndrome. Recent studies have found that blocking cells' glucocorticoid receptors reduces the proliferation of Kaposi's sarcoma tissue, and that blocking these receptors also might inhibit HIV itself.
Becker muscular dystrophy Benign Xlinked muscular dystrophy with later onset and lower severity than Duchenne muscular
Beckwith-Wiedemann syndrome Rare developmental disorder with a complex pattern of inheritance suggesting a defect in maternal genomic imprinting. Characteristics are all growth abnormalities - enlarged tongue, gigantism, enlarged adrenal glands, enlarged visceral organs, advanced ageing and predisposition to childhood tumours. Possibly due to a defect in the cyclin-dependent kinase inhibitor, p57 KIP2, though in some cases there are two copies of the IGF-2 gene (see insulin-like growth factor).
Fear or anger in one part of the brain, which induces the hypothalamus to send an urgent message to the pituitary gland's anterior lobe to release the stress hormone adrenocorticotrophic hormone (acth) into the blood. ACTH enters the adrenal glands located on top of the kidneys, producing more stress-associated hormones (epinephrine and norepinephrine). Due to this increase in systemic epinephrine and norepinephrine, drastic changes affect the body's blood supply as the heart races, blood vessels supplying the skin and digestive system constrict, draining color from the skin. This shunts blood to the vital musculature where it is needed. The chest expands, widening bronchial tubes and increasing respiration rate muscles tense, pupils dilate the mouth grows dry and the body sweats.
Hydrocortisone The corticosteroid hormone produced by the adrenal cortex and produced synthetically. It is essential in maintaining life, sustaining blood pressure, and providing mineralocorticoid activity. Used in the treatment of various ailments, e.g., allergies, collagen abnormalities, inflammations, and certain neoplasms. Many people with advanced HIV disease have decreased adrenal gland function. Hydrocortisone is often used by them as replacement therapy to correct the low natural level. Hydrocortisone is available in a number of formulations. Skin creams containing 0.5 percent to 1.0 percent hydrocortisone are available over the counter. More concentrated preparations
The cells of the adrenal cortex (a part of your adrenal gland) also produce low levels of both estrogen and testosterone. Sometimes as a consequence of overactivity of the adrenal gland during development or of a defect in hormone synthesis, high levels of either estrogen or testosterone can be produced by the adrenal cortex. Congenital adrenal hyperplasia is not an inter-sex condition for males, but it is for females. Thus a developing female fetus could be exposed to high levels of both testosterone (from the adrenal cortex) and estrogen (from the ovaries). The result is a mixture or confusion of developmental processes, resulting in a newborn whose genitals seem to be a little of both, or in some cases may even appear to be clearly male. These cases of ambiguous genitalia are quite disturbing to some parents and physicians, who may rapidly push to make the child's situation unambiguous at a very early age, before the child begins experiencing a wide array of sex-specific social...
Although there is a lack of functional evidence for role of PDGF-D in kidney development, Bergsten et al. (2) used a polyclonal antibody raised against a peptide representing amino acids 254-272 of PDGF-D to examine in situ PDGF-D protein expression. PDGF-D was shown to be most abundantly expressed in the fibrous capsule surrounding the developing mouse kidney and the adjacent adrenal gland. Staining was also observed in the metanephric mesenchyme in the cortical region of the kidney and in the branching ureter in the medullar region. The authors noted that no PDGF-D staining was observed in the developing nephron, including the ureter buds, glomeruli, and Henle's loops. Contrasting the mouse expression data, the developing human kidney was shown to express PDGF-D in epithelial cells of comma and S-shaped structures of the developing nephron and, in later differentiation, the visceral epithelial cells in the glomerulus (35). Staining was also observed in mesenchymal cells in the...
The endocrine system has long been divided into two main components the classic endocrine system, including the pituitary gland, the thyroid gland, the adrenals, the parathyroid glands, the pancreatic islets, the ovary or testes, and then the diffusely dispersed endocrine system located as single cells or cell clusters in various nonendocrine organs.
Neuroblastomas characteristically affect children and are extremely rare in adults. The tumors are localized along the sympathetic cord. Their main localization is at the level of the adrenal glands, but they can also be found in the retrothoracic area up to the cervical region (near to the ganglion stellatum) (Fig. 28). Abdominal localizations below the region of adrenals to the pelvis are possible, and in rare cases neuroblastomas may even develop in the regions of upper parts of the thigh. Because the most frequent localization is the retroperitoneal area, all childhood cancers with this localization must be taken into consideration.
The wtl gene shows a definable pattern, both temporal and spatial, of expression in the developing kidney. Its expression is first detectable in the intermediate mesenchyme lateral to the coelomic cavity of 13-somite early 9-day embryos, then in the urogenital ridge (early mesonephric tubules). The uninduced metanephric mesenchyme shows wtl expression by 11 days and soon this is followed by enhancement of its expression in the induced mesenchyme of the kidney and markedly in the nephrogenic condensations later in the development of the kidney, it is restricted to the glomeruli (Armstrong et al., 1993). No expression is found in the proximal or distal tubules and loop of Henle. The genital ridge, fetal gonad and mesothelium are other major sites of wtl expression. No expression is found in fetal heart, skin, adrenal gland, stomach, liver, eye or muscle (Pritchard-Jones et al., 1990). The suppression of myogenesis during kidney development may also be a normal function of wtl (Miyagawa...
The 5-HT4 receptors modulate the activities of channels and transporters by increasing cAMP levels. These include activation of L-type Ca2+ channels (326), chloride currents in human jejunal mucosa and rat distal colon (330,331), and the If pacemaker current in atrial myocytes (332) and stimulation of aldosterone release from the adrenal glands (333,334), striatal dopamine release (324), hippocampal and frontal cortex acetylcholine release (335,336), and hippocampal 5-HT release (337). 5-HT4 receptors also inhibit various channels, including a KV3.2-like delayed rectifier K+ channel (303), a voltage-activated K+ channel in colliculi neurons (320,338), a Ca2+-activated, afterhyperpolariz-ing, and K+ current in hippocampus (325).
The rat 5-HT6 receptor DNA was cloned by two groups in 1993 (354,355). The human 5-HT6 receptor was cloned in 1996 (356) and the murine receptor was cloned in 2001 (357). The 5-HT6 receptor gene contains two introns (354,355), and the human gene encodes a 440-amino-acid protein (356). The 5-HT6 receptor has high affinities for typical and atypical antipsychotic, antidepressant, and psychotropic drugs. It is expressed primarily in the brain, with lower levels in the stomach and adrenal gland (354,355). Antibodies, antisense oligonu-cleotides, and radioligand-binding studies suggest that the 5-HT6 receptor is abundant in several brain regions, including cortical and limbic brain regions, the olfactory tubercle, caudate nucleus, hippocampus, nucleus accumbens, and stria-tum (358-362). Interestingly, the 5-HT6 receptor regulates cholinergic and gluta-matergic neuronal activity (rather than dopaminergic) and has been proposed as a regulator of feeding, cognition, emotion, learning, and...
The 5-HT7 receptors also are expressed in the periphery, where their best characterized function is to mediate relaxation of vascular smooth muscle (397). In particular, 5-HT7 receptors are expressed throughout the gut (398) and stomach (399), as well as in vasculature (400,401). 5-HT7 receptors are also expressed in adrenal glomerulosa cells (402,403) and corneal epithelial cells (404). In the adrenal gland, 5-HT7 receptors stimulate the release of aldos-terone from adrenal glomerulosa cells (402,403) by increasing cAMP levels.
Deficiency disorders include beriberi, pellagra, digestive disturbances, enlargement of the liver, disturbance of the thyroid, degeneration of sex glands, and neurological disturbances. Vitamin B deficiencies induce edema affect the heart, liver, spleen, and kidneys enlarge the adrenals and cause dysfunction of the pituitary and salivary glands. Dietary sources of thiamine include red meat, whole grains, potatoes, peas, beans, nuts, and yeast. As this nutrient is water-soluble, it can be lost when food is cooked in liquids.
Alkaline, presumably because of a relative deficiency of acid-producing vaginal microbes (4,5). Vulvar skin thickness decreases and the mons pubis and labia majora lose some of the subcutaneous fat present at birth (6,7). Although the full complement of vulvar hair follicles and sebaceous glands is thought to be present from birth, these structures do not mature until the adrenal glands are activated at puberty. The prepubescent labia minora have barely discernible vellus hair follicles that are lost at puberty when the follicles of the labia majora and mons pubis terminally differentiate (6). The appearance of the prepubescent hymen is variable. Two common forms in girls more than three years of age are Maturation of the adrenal glands and androgen secretion (adrenarche) begin at about age six, approximately two years before pituitary-gonadal maturation and the production of ovarian steroid hormones (gonadarche). Because adrenarche and gonadarche proceed independently, the appearance...
Adrenaline Secreted by the adrenal glands, this neurotransmitter and hormone readies the body for action. Adrenaline is also known as epinephrine. The release of adrenaline increases heart rate and blood pressure, and diverts blood flow from the skin and gastrointestinal area to parts of the body where it is needed in times of survival-oriented action. adrenocorticotropic hormone (ACTH) Also called corticotropin, this hormone is produced by the pituitary gland and stimulates the outer layer of the adrenal gland to release various corticos-teroid hormones. ACTH is also needed to maintain the adrenal cortex cells. ACTH production is partly controlled by the hypothalamus (an area in the center of the brain) and partly by the level of hydrocortisone in the blood.
Low levels of estrogen from the adrenals signal female development. Do AIS women (with XY karyotype and no functional androgen receptor) have the same characteristics as TDF-negative women (with XY karyotype and no functional TDF protein) No. Recall that the TDF-negative woman, in the absence of the TDF signal, has produced female gonads, which provide an estrogen-dominated hormonal environment. Although they are infertile because their meiotic processes needed two copies of the X chromosome, they have a full set of female anatomy. The AIS woman, with an active TDF signal, has male gonads, only as much estrogen as the adrenal glands can supply, and no ovaries or uterus. Thus a TDF woman would be harder to identify without genetic testing, and an AIS woman has cancer risk to deal with in addition to infertility.
The von Hippel-Lindau disease is a hereditary multisystem cancer syndrome caused by germline mutations of the VHL tumor suppressor gene on the short arm of chromosome 3 (reviewed in ref. 60). The disease predisposes to the development of a variety of highly vascularized benign and malignant tumors of the central nervous system, adrenal glands, pancreas reproductive adnenal organs, and the kidney. VHL disease is the principal cause of inherited RCC. Furthermore, in almost 100 of the sporadic ccRCC, there is an inac-tivation of the VHL gene either by mutation, deletion, or methylation (61,62).
Dehydroepiandrosterone (DHEA) Produced by the adrenal glands, DHEA is the most abundant steroid hormone in the body. The body converts this hormone to whatever particular hormone is needed at any specific time, including testosterone and estrogen. Blood level of DHEA decreases in the body after the age of 20, and by the age of 80, the
Adrenocortical carcinoma is a rare tumor afflicting only one to two persons per one million population. It usually occurs in adults, and the median age at diagnosis is 44 years. Although potentially curable at early stages, only 30 of these malignancies are confined to the adrenal gland at the time of diagnosis.35 Approximately 60 of patients present with symptoms related to excessive hormone secretion, but hormone testing reveals that 60 -80 of tumors are functioning.36 Nonfunctioning carcinomas may be heralded by symptoms of local invasion by tumor or by metastases. Initial evaluation should include, in addition to appropriate endocrine studies, computed tomography and or magnetic resonance imaging of the abdomen. Selective angiography and adrenal venography may be helpful for smaller lesions and for distinguishing tumors of the adrenal gland from tumors of the upper pole of the kidney. The detection of metastatic lesions may allow effective palliation of both functioning and...
Besides the well-known possibility of metastatic involvement of brain, liver, kidney, and skeleton, the possibility of so-called endocrine metastasis into the thyroid gland, the adrenals, and the pancreas must also be considered and should be carefully checked for by means of the radiodiagnostic imaging techniques (Fig. 5).
Finally, the question has been raised as to whether excessive stress can predispose to neurodegenerative disease. When an animal or human is stressed, one of the things that happens is an increased release of glucocorticoids from the adrenal glands. In the short term glucocorticoids are helpful to a stressed animal. Among other things, they promote the breakdown of protein to glucose, helping to make fat available for use and increasing blood flow. With prolonged stress and a prolonged release, the glucocor-ticoids can have damaging effects, including increased blood pressure, gastric ulcers, and depression of the immune system. The situation with regard to stress and the aging human brain is by no means clear, but some studies on aging people suggest a relation between stress hormones and difficulties with memory tasks. In one study, 11 healthy subjects in their sixties or seventies were followed for four years. Of these, six showed increased levels of cortisol, one of the main...
Humans, other primates and guinea pigs depend on external sources of vitamin C for their requirements most other animals synthesise ascorbic acid within the body. The vitamin C content in body tissues varies widely with highest concentrations in the pituitary, adrenals, leukocytes, eye lens and brain and the lowest levels in plasma and saliva (Thurnham, 2000). The ascorbic acid (AA) body pool in adults has been determined using isotope labelled AA as a tracer. Pharmaco-kinetic data was obtained from healthy men given doses of 1-14C labelled AA with steady-state intakes of 30 to 180mg d AA. The data showed the body halflife of AA was inversely related to intake up to a maximum of 20mg kg body weight, corresponding to a plasma AA concentration of 57 mmol L, and an AA intake of 100mg d (Kallner et al, 1981). In normal adults about 2.7 of the exchangeable body pool of ascorbate is degraded each day, which is independent of body pool size (Baker et al, 1971 Kallner et al, 1979).
If cells were editors, they'd point out that the complete sentence, as spoken by the adrenal gland to the liver cell, goes like this adrenaline -adrenergic receptor Gs adenylyl cyclase cAMP cyclic AMP protein kinase (or PKA heading the relay between receptor and target, it's the first protein to heed cyclic AMP's call) phospho-rylase kinase (Sutherland's kinase, it's phosphorylated and activated by PKA) glycogen phosphorylase THEN G y G proteincoupled receptor kinase ( GRK, for short) -adrenergic receptor (phosphorylated by GRK) -arrestin OR PKA -adrenergic receptor (phosphorylated by PKA) G AND THEN well, more about that in a moment.
Epinephrine Also known as adrenaline, this is a naturally occurring hormone and neurotransmitter that has been synthetically manufactured since 1900. It is one of two chemicals (the other is norepinephrine) released by the adrenal gland in response to signals from the sympathetic division of the autonomic nervous system. The signals are triggered by exercise, stress, and emotions such as fear.
HIV-related fatigue has a variety of interactive causes, of which psychological distress and depression are just one aspect. physical symptoms, drug side effects, sleep disturbances, malnutrition and wasting, HIV encephalopathy, hormonal insufficiency (due to low adrenal gland output, for example), and muscular weakness (HIV- or AZT-related myopathy) all contribute to fatigue. Researchers have also noted a small but statistically significant association between fatigue and anemia (low oxygen transport by the blood).
Hypocretin neurons are modulated by adrenergic input (53). Moreover, centrally administered hypocretin activates the hypothalamic-pituitary-adrenal (HPA) axis in rats (45,54), induces plasma adrenocorticotropin hormone (ACTH) and corticosterone (48,54,55) and c-fos mRNA in the parvocellular division of the PVN (Fig. 1). In addition, glucocorticoids modulate hypothalamic hypocretin mRNA expression (56), suggesting that this system could constitute a sensitive key relay for mediating stress behavior. Interestingly, hypocretin receptors have been detected in adrenal gland hypocretin-1 receptor is expressed in the cortex of the normal human adrenal gland (glomerulosa, fasciculate, and reticular zones), and hypocretin-2 receptor is located in the medulla (epinephrine and norepinephrine cells) (57,58). Also, addition of hypocretin to adrenocortical cultures stimulates norepinephrin release (59). However, the origin of the ligand that would bind to hypocretin receptors in the periphery is...
Beyond the effects on glucose and insulin, Cr supplementation has clearly affected serum cortisol levels in multiple species. Whether this is a direct effect of Cr on the adrenal gland or an indirect effect via alterations of insulin is not determined. However, the adverse effects of excess glucocorticoids such as cortisol are well known. The excesses inhibit fibroblasts which can lead to a loss of collagen and connective tissue, which then can manifest itself as easy bruising and poor wound healing. Negative effects can also be observed on bone formation and calcium absorption, as well as general growth and development in children. A host of other effects related to immunocompetence, renal function, cardiovascular function, and decreased libido are known. But, while these effects of gross glucocorticoid excess are known, whether the smaller moderations that result from Cr supplementation will have effects on long-term health and well-being are less certain.
This subspecialty involves the study of hormones, endocrine glands, and their effects on whole-body homeostasis. You will find an intimate connection between the latest basic science research and its application in bedside clinical practice. Endocrinologists are experts in treating disease states in which glands (pituitary, thyroid, adrenal, pancreas, gonadal) are either overproducing or undersecreting hormones. These problems include diabetes, thyroid dysfunction, gonadal disorders, pituitary tumors, adrenal gland dysfunction, and disorders of bone metabolism. Patients often live with chronic endocrine diseases that may not declare themselves for weeks or even years (other than a few subtle symptoms). Many of these diseases are treatable, often even curable.
Expression of PDGFD transcripts and PDGF-D protein has been studied in various normal and diseased tissues. Using real-time quantitative polymerase chain reaction (RTQ-PCR) analysis, the PDGFD gene was shown to be expressed at relatively high levels in the adrenal gland (3). Lower levels were shown in the pancreas, adipose tissue, salivary gland, pituitary gland, mammary gland, ovary, testis, and pancreas. Northern blot analysis showed highest expression in the ovary, heart, and pancreas and also demonstrated expression in the placenta, liver, small intestine, and kidney but revealed little to no expression in brain or skeletal muscle (2). Message was also detected in human umbilical vein endothelial cells (HUVEC) and human microvascular endothelial cells (HMVEC) cells (6), as well as adult motor neurons (1). Bleomycin induces a fibrotic injury to mouse and human lungs. On examination of mRNA levels by Northern analysis, lungs from mice treated with bleomycin demonstrated a decline in...
Sites of infection include the lungs, liver, heart, skin, lymph nodes, adrenal glands, and genitourinary tract. Diagnosis of cryptococcal meningitis is important because early treatment of the disease can be very effective. Note that there are also other causes of meningitis in HIV-infected patients. These include the bacterium that causes TB and possibly HIV itself.
Congenital adrenal hyperplasia This group of disorders involves a deficiency of certain hormones produced by the adrenal gland that can affect genital development and may cause a fatal loss of salt from the kidneys. Lifelong supplementation of the missing hormones controls the condition.
TTP is associated with the deposition of platelet-rich hyaline thrombi within the microcirculation of the brain, kidneys, heart, pancreas, spleen, adrenal glands, and other organ systems. In a majority of patients with TTP, the formation of these thrombi has been attributed to the abnormal accumulation of unusually large (UL) von Willebrand factor (vWF) multimers. vWF is synthesized in endothelial cells and assembled into multimers ranging in size from small dimers to huge unusually large multimers (ULvWF). When released into the plasma, ULvWF multimers are quickly reduced in size by a vWF-specific protease called ADAMTS-13 (a disintegrinlike and metalloprotease with thrombospondin type 1 repeats). Very low or absent ADAMTS13 activity is associated with accumulation of ULvWF multimers, which can then attach to platelets and promote platelet activation and aggregation, leading to the formation of platelet thrombi. Patients with the familial form of TTP have severe deficiencies of...
We believe that a reasonable pancreatic endocrine surveillance program should include both biochemical tests and imaging studies including computed tomography (CT) and EUS. CT scanning is recommended because of its ability to visualize other organs such as the liver and adrenal glands, whereas EUS is felt to be the best imaging modality for the pancreas.
A new drug was being tested at a pharmaceutical company. The first tests were carried out in isolated liver cells in vitro, and the drug was found to be not toxic to these cells. The drug was then given to experimental animals, in which it caused the destruction of the adrenal glands (which are found close to the kidneys). When cells from the adrenal gland were used instead of liver cells in in vitro tests, they were, as expected, destroyed. This was because the cells from the adrenal gland were not able to detoxify the drug whereas the liver cells were. If the ability of the liver cells to detoxify the drug were blocked, they too became susceptible to the toxic effect of the drug. Liver cells are the cells most often used in vitro because they are the easiest to prepare and use. They are also often the most readily available kinds of human cell. The toxicity illustrated by this example could easily occur in humans if isolated cells alone were used to test new chemicals.
Corticosteroids are also called glucocorticoids or sometimes just steroids. They are related to cortisone, a stress hormone produced by the adrenal gland, and differ from anabolic steroids used by some athletes to increase muscle strength. Corticosteroids, acting through glucocorticoid receptors found on most cells, suppress the immune response. Various preparations are used to treat rheumatic diseases. DHEA (dehydroepiandrosterone) (Available in health food stores in the form of natural products food supplements) DHEA is a precursor hormone secreted by the adrenal gland that is converted to the androgenic (male) hormones androstenedione, testosterone, and androsterone and the estrogenic (female) hormone estradiol. In limited clinical studies DHEA resulted in a small decrease in the corticosteroid requirements in patients with mild SLE and an increase in bone density. It is also promoted as an antiaging hormone with little scientific support.
Oral health is important because the condition of the mouth is often indicative of the condition of the body as a whole. More than 90 percent of systemic diseases have oral manifestations. These diseases include immune deficiency (e.g., HIV AIDS), viral diseases (e.g., herpes and mumps), cancer and leukemia, diabetes, heart disease, kidney disease, anemia, hemophilia and other bleeding disorders, adrenal gland disorders, and inflammatory bowel disease (Bajuscak, 1999 Glick, 1999). Also, poor oral health can lead to poor general health. Infections in the mouth can enter the bloodstream and affect the functioning of major organs (e.g., bacterial endocarditis, in which infection causes the lining of the heart and the heart valves to become inflamed) (Meadows, 1999). Poor oral care can also contribute to oral cancer, and untreated tooth decay can lead to tooth abscess, tooth loss, and in the worst cases serious destruction of the jawbone (Meadows, 1999).