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KELENJAR ADRENAL
dr Aris Prasetyo,M Kes
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Anatomi
Kuning
Berbentuk pyramid
Kelenjar suprarenal ,terletak di sisi atas ginjal Banyak vascularisasi
Berat + 7. g
Kelenjar adrenal dibagi ! bagian"# cortex adrenal di permukaan# medulla adrenal di lapisan dalam
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Cortex Adrenal Kekuningan $ simpanan lipids, c%olesterol dan
asam lemak.
Memproduksi %ormones steroid, oki disebut
adrenocortical steroid, atau diseder%anakancorticosteroid
Korticosteroid vital
&ormon steroid, menimbulkan e''ek denganmemili% gen dengan ditranskrip ke nukleus seltarget.
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3 Zones,dari corte( adrenal "
)*zona glomerulosa, diluar
)!zona fasciculata,di tengah
)zona reticularis, di dalam
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Region/Zone
Hormone(s !arget Hormonal E""ects Regulator# Control
Cortex
-ona
glomerulosa
Mineralocorticoid
s )M, primarilyaldosterone
Kidney /ncrease renal reabsorption
o' 0a+
and 1ater )especiallyin t%e presence o' A2& andaccelerate urinary loss o' K+
3timulated by
angiotensin //4in%ibited by A0P
-ona'asciculata
5lucocorticoids)5" cortisol)%ydrocortisone,
corticosterone,cortisone
Mostcells
6elease o' amino acids 'romskeletal muscles, and lipids'rom adipose tissues4
promote liver 'ormation4promote perip%eral glycogenutiliation o' lipids4 anti$in'lammatory e''ects
3timulated by A8&'rom anteriorpituitary gland
-ona
reticularis
Androgens 9ncertain signi'icance under
normal conditions
3timulated by
A8&4 signi'icanceuncertain
$edulla :pinep%rine,norepinep%rine
Mostcells
/ncrease cardiac activity,blood pressure, glycogenbreakdo1n, blood glucoselevels4 release o' lipids byadipose tissue
3timulated duringsympat%eticactivation bysympat%eticpreganglionic 'ibers
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Zona %lomerulosa memproduksi mineralocorticoid)Ms,
%ormon steroid
mempengaru%i komposisi electrolyte cairan tubu%.
Aldosteronadala% mineralocorticoid terpenting
+* persen volume cortical
glomerulusadala% bola$bola kecil
Bentuk kecil, padat, bergerombol
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Aldosterone $erangsang pertam&a'an ion sodium dan
eliminasi ion potassium #ang mengatur
komposisi cairan ekskresi
)ni men#e&a&kan retensi ion sodium di
gin*al+ kelen*ar keringat+kelen*ar sali,a dan
pancreas
mencega' ke'ilangan Na- di urine+
keringat+ sali,a+ dan digesti,e
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Retensi Na- disertai ke'ilangan K-
.e&agai e"ek samping+ rea&sorpsi Na-meningkatkan rea&sorpsi osmotik di gin*al+
kelen*ar keringat+ kelen*ar sali,a dan
pancreas
Aldosterone meningkatkan sensiti"itas
receptor garam di taste &uds di lida'
Aki&atn#a peningkatan keinginan
mengkonsumsi asinasin
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%angguan Aldosteron '#poaldosteronism
5agal memproduksi aldosterone dalam
jumla% cukup.
Ke%ilangan sejumla% besar air dan 0a+
Menguba% konsentrasi elektrolit
transmembrane potentials, 5angguan jaringan neural dan otot
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H#peraldosteronisme
2itandai dengan &ipertensi dan &ipokalemi
Macam "
Primer " 3indroma onn
3ekunder#3tenosis arteri renalis
#3irosis#Paya% jantung
#3indrom ne'rotik
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Aldosteronisme Primer
;anita
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2iagnosa
&iperaldosteron dan kadar renin yang
renda% dalam plasma
8 3can
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8erapi
Adrenalektomi
Posterior
Prabeda% " spironolakton !
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Zona 0asciculata
)fasciculus,ikatan kecil
memproduksi %ormon steroid "
glucocorticoids)5s
:''ek " metabolisme glucose
+7? persen volume kortek
3el endocrinenya besar dan mengandungbanyak lipid, tampak berbusa
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Glucocorticoids
2irangsang A8& dari %ipo'ise anterior
Produk terpentingnya cortisol, disebut juga
hydrocortisone dengan jumla% yang lebi% kecil dalam bentukcorticosterone dan cortisone
3ekresi 5lucocorticoid di regulasi dengan negative
'eedback" pelepasan glucocorticoids mempunyaie'ek meng%ambat produksi corticotropin$releasing%ormone )6& di %ypot%alamus dan A8& di%ipo'ise anterior
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antiin"lammator# e""ect
meng%ambat akti'itas sel leukosit dankomponen sistem imun lain
3teroid cream biasa digunakan mengatasi
alergi injeksi glucocorticoid mengatasi reaksi
alergi yang lebi% berat
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%angguan 1roduksi
%lucocorticoid Addison2s disease
#produksi glucocorticoid inadeuate
#autoimmune response#kelema%an dan ke%ilangan berat badan
#tidak dapat menggunakan cadangan lipid secarae'ekti' untuk memproduksi A8P
#konsentrasi glucose dara% turun se%abis makan#symptom mirip %ypoaldosteronism
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2iagnosa
#8es lab#Kadar kalium plasma meningkat
#Kadar natrium dan klorida normal
#A8& serum meningkat 8erapi
#airan iv
#Kortikosteroid iv po
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Cus'ing2s disease
#@verproduksi glucocorticoids
#2iagnosa banding " esi %ipo'isis menyebabkan&ypersekresi A8&
#Metabolism 5lucose ditekan
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5ejala
;anitaCC
5ejala kelebi%an sekresi kortisol"
#Atro'i otot, protein peri'er dipeca%
#@besitas, cadangan lipid dimobilisasi $ Dmoon$
'acedD appearance
#3triae#%iperpigmentasi
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2iagnosa
Kadar A8& plasma renda%
8 3can untuk menyingkirkan karena lesi
%ipo'isis
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Zona Reticularis
Reticulum =net1ork
7 E corte( adrenal
branc%ing net1ork
memproduksi androgens
selain di testis
juga memproduksi estrogens
e''ek pada se(ual c%aracteristics A8& merangsang ona reticularis tapi
minimal
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%angguan pada Zona Reticularis
8umor
androgen meningkat drastis
adrenogenital syndrome
pada 1anita$maskulin
#postur tubu%
#bulu>rambut
#distribusi tumpukan lemak
#berotot
pada laki$laki$ 'eminin
#gynecomastia )gynaikos,1oman + mastos,breast.
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$edulla Adrenal
ber1arna coklat kemera%an$ kaya pembulu%dara%
3elnya bulatF mirip ganglion sympat%eticyang diinnervasi ole% preganglionicsympat%etic 'ibers
akti'itas sekresi dikontrol ole% divisisympat%etic dari sara' otonom
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medulla adrenal mengandung dua kelompoksel sekretory"
#epinep%rine )adrenaline#norepinep%rine )noradrenaline.
3ekresinya dikemas dalam vesicles
e(ocytosis 6angsangan sympatis merangsang
peningkatan e(ocytosis dan pelepasan %ormonsecara dramatis
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$edulla Adrenal
1reganglionic "i&ersmasuk ke medulla adrenal
medulla adrenal adala% modi'ikasi ganglion
simpatis 2i dalam medulla, preganglionic 'ibers melakukan
synapse pada sel neuroendocrine,neurons k%ususyang melepas neurotransmitters epinephrine (E
dan norepinephrine (!Eke sirkulasi.
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$em&rane Receptors
Ada ! kelompok sympat%etic receptors"
#alpha receptors
#"eta receptors.
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Alpha Receptors
3timulasi alp'a receptorsmengakti'kan enym dimembran sel.
Ada ! tipe alp%a receptors"# alp%a$*
# alp%a$!
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Kelainan $edullaeAdrenal
4,erproduksi epinep'rine ole' medullaadrenal
1'eoc'romoc#toma
!umor #ang memproduksi catec'olamin 55
!'e most dangerous s#mptoms are rapid andirregular 'eart&eat and 'ig' &lood pressure6
4t'er s#mptoms include uneasiness+ s7eating+&lurred ,ision+ and 'eadac'es
.urgical remo,al o" t'e tumor is t'e moste""ecti,e treatment
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Pancreas
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pancreatic islets
islets of #angerhans.
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/nsulin
Peptide %ormone
released by beta cells 1%en glucose levels
rise above normal levels )7dl. /nsulin secretion is also stimulated by
elevated levels o' some amino acids,
including arginine and leucine. Binds to receptor proteins on t%e cellmembrane. .
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@ne o' t%e most important e''ects is t%e
en%ancement o' glucose absorption and utiliation /nsulin receptors are present in most cellmembranes4 suc% cells are called insulin-dependent.
ells in t%e brain and kidneys, cells in t%e liningo' t%e digestive tract, and red blood cells lackinsulin receptors.
8%ese cells are called insulin-independent,because t%ey can absorb and utilie glucose1it%out insulin stimulation.
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8%e e''ects o' insulin on its target cells
include" $cceleration of glucose uptake (all target cells.
$cceleration of glucose utilization (all target
cells and enhanced $%& production.
'timulation of glycogen formation (skeletalmuscles and lier cells.
'timulation of amino acid a"sorption and protein
synthesis.
'timulation of triglyceride formation in adipose
tissues.
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/nsulin is secreted 1%en glucose is
abundant, and t%is %ormone stimulates
glucose utiliation to support gro1t% and t%eestablis%ment o' carbo%ydrate )glycogen
and lipid )triglyceride reserves.
8%e accelerated use o' glucose soon bringscirculating glucose levels 1it%in normal
limits.
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2iabetes Mellitus
2iabetes mellitus )mellitum,%oney isc%aracteried by glucose concentrations t%at are%ig% enoug% to over1%elm t%e reabsorption
capabilities o' t%e kidneys.
5lucose appears in t%e urine )glycosuria, and urineproduction generally becomes e(cessive )polyuria.
@t%er metabolic products, suc% as 'atty acids andot%er lipids, are also present in abnormalconcentrations.
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aused by genetic abnormalities, and some o' t%e
genes responsible %ave been identi'ied
# inadeuate insulin production
# t%e synt%esis o' abnormal insulin molecules
# de'ective receptor
2iabetes mellitus may also appear as t%e result o'ot%er pat%ological conditions, injuries, immune
disorders, or %ormonal imbalances
8%ere are t1o major types o' diabetes mellitus"
# insulin)dependent (%ype * dia"etesand
# non)insulin)dependent (%ype ** dia"etes.
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)nsulinDependent Dia&etes
$ellitus 8ype / diabetes,
inadeuate insulin production by t%e beta cells o'
t%e pancreatic islets. 5lucose transport in most cells cannot occur in t%eabsence o' insulin.
;%en insulin concentrations decline, cells can no
longer absorb glucose4 tissues remain glucose$starved despite t%e presence o' adeuate or evene(cessive amounts o' glucose in t%e circulation.
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A'ter a meal ric% in glucose, blood glucoseconcentrations may become so elevated t%at t%ekidney cells cannot reclaim all t%e glucosemolecules t%at enter t%e urine.
8%e %ig% urinary concentration o' glucose limits
t%e ability o' t%e kidneys to conserve 1ater, so t%eindividual urinates 'reuently and may becomede%ydrated.
8%e c%ronic de%ydration leads to disturbances o'
neural 'unction )blurred vision, tinglingsensations, disorientation, 'atigue and muscle1eakness.
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under =< years o' age.
juvenile$onset diabetes.
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0on$insulin$dependent diabetes
mellitus )0/22M 8ype // diabetes, typically a''ects obese
individuals over =< year o' age.
8ype // diabetes is 'ar more common t%an8ype / diabetes
H< percent o' t%em involve obese
individuals.
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8%e primary e''ects o' glucagon "
'timulation of glycogen "reakdo+n in
skeletal muscle and lier cells.
'timulation of triglyceride "reakdo+n inadipose tissues.
'timulation of glucose production at the
lier.
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Structure/Cells
Hormone
PrimaryTargets Hormonal Effects Regulatory Control
Alphacells
Glucagon
Liver,adiposetissues
Mobilizes lipid reserves;promotes glucose synthesis
and glycogen breakdown inliver; elevates blood glucoseconcentrations
Stimulated by low blood glucoseconcentrations; inhibited bysomatostatin from delta cells
Betacells Insulin Most cells
acilitates uptake of glucoseby target cells; stimulates lipid
and glycogen formation andstorage
Stimulated by high blood glucoseconcentrations, parasympatheticstimulation, and high levels ofsome amino acids; inhibited by
somatostatin from delta cells andby sympathetic activation
Deltacells
Somatostatin!G"#I"$
%ther isletcells,digestiveepithelium
Inhibits insulin and glucagonsecretion; slows rates ofnutrient absorption andenzyme secretion alongdigestive tract
Stimulated by protein#rich meal;mechanism uncertain
F cells
&ancreaticpolypeptide
'igestiveorgans
Inhibits gallbladder contraction;regulates production ofpancreatic enzymes;influences rate of nutrientabsorption by digestive tract
Stimulated by protein#rich mealand by parasympatheticstimulation
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