The Endocrine System – The Adrenal Glands

The adrenal glands are small triangular-shaped structures located at the top of both kidneys. Their function is to produce hormones that help in the regulation of the metabolism, immune system, blood pressure, stress response, and more.

adrenal glands
Retrieved from https://www.jaypeedigital.com/book/9789350903025/chapter/ch16 on 12th March 2022

The adrenal glands, which are covered by an inner thick layer of connective tissue with an outer thin fibrous capsule, contain two sections:

  1. OUTER ADRENAL CORTEX – makes up the biggest part of the gland
  2. INNER ADRENAL MEDULLA – the core

The OUTER ADRENAL CORTEX is made up of 3 parts:

  1. Zona Glomerulosa – makes up 15% of the total volume (secretes mineralocorticoids)
  2. Zona Fasciculata – makes up the widest part of the total volume (mainly secretes glucocorticoids)
  3. Zona Reticularis – secretes amounts of hormones, mostly gonadocorticoids and androgens
adrenal glands
Retrieved from https://www.majordifferences.com/2014/04/difference-between-adrenal-cortex-and.html on 12th March 2022

Adrenal Cortex vs Adrenal Medulla

Mineralocorticoids

Mineralocorticoids are responsible for water and electrolyte homeostasis through control of sodium and potassium concentrations. 95% of all mineralocorticoid activity happens through Aldosterone:

  1. Aldosterone acts on the kidneys’ tubule cells, causing them to increase sodium reabsorption
  2. Sodium ions are removed from the urine and returned to the blood
  3. Rapid depletion of sodium from the body is prevented

Aldosterone causes:

  • potassium excretion
  • sodium reabsorption
  • hydrogen ions elimination
  • sodium, chloride, and bicarbonate ions retention
  • water retention

NOTE: Aldosterone reduces potassium reabsorption, thus, large potassium amounts are lost in urine excretion.

Electrolyte balance Secondary Effects

Sodium retention and potassium excretion lead to secondary effects:

  • Sodium reabsorption causes Hydrogen ions to pass into the urine to replace positive sodium ions, making the blood less acidic, thus preventing acidosis.
  • Sodium ions movement creates a positively charged field in the blood vessels surrounding the kidney tubules. This causes Chloride and Bicarbonate ions to move out from urine, back into the blood.
  • When ADH (antidiuretic hormone) is present, increased sodium concentration in the blood vessels causes water to move by osmosis from the urine into the blood.

Aldosterone control #1 – the raas system

RAAS system
Retrieved from https://www.pinterest.com/pin/557813103821299549/ on 13th March 2022

Aldosterone Control #2 – Potassium Ion Concentration

  1. Increased potassium concentration in extracellular fluid causes the adrenal cortex to secrete aldosterone
  2. Aldosterone secretion causes excess potassium to be eliminated by the kidneys
  3. Decreased potassium concentration in the extracellular fluid causes a decrease in aldosterone production, leading to less potassium excretion by the kidneys

Glucocorticoids

Glucocorticoids promote normal metabolism by:

  • increasing the rate of protein catabolism
  • increasing the rate at which amino acids are removed from cells and transported to the liver to undergo protein synthesis
  • releasing fatty acids from adipose tissue to be converted into glucose
  • promoting gluconeogenesis

Glucocorticoids promote stress resistance:

  • gluconeogenesis from amino acids causes a sudden increase in glucose availability, prompting the body to become more alert
  • blood vessels become more sensitive to chemicals that cause vasoconstriction so as to allow an increase in blood pressure

Glucocorticoids are anti-inflammatory compounds:

  • cause a reduction in mast cells
  • stabilise lyosomal membranes, leading to the inhibition of histamine release
  • decrease blood capillary permeability
  • depress phagocytosis by monocytes

Glucocorticoids:

  • Cortisol (hydrocortisone) – most abundant and responsible for about 95% of all glucocorticoid activity
  • Corticosterone
  • Cortisone

NOTE: Cortisol Serum blood test indicates adrenal function.

NOTE: Glucocorticoids slow down connective tissue regeneration, which leads to slow wound healing.

NOTE: Steroids are a synthetic form of glucocorticoids.

ACTH (Adrenocorticotropic hormone) Control

Glucocorticoid secretion is controlled through a negative feedback mechanism stimulated by stress and low blood glucocorticoid level:

  1. stress and low blood glucocorticoid level stimulate the hypothalamus to secrete CRF (corticotropin releasing factor)
  2. CRF secretion causes ACTH to be released from the anterior lobe of the pituitary
  3. ACTH is carried to the adrenal cortex, where it stimulates glucocorticoid secretion
adrenal glands
Retrieved from https://quizlet.com/279451837/chapter-9-vocabulary-flash-cards/ on 13th March 2022

Gonadocorticoids

The adrenal cortex is responsible for the secretion of both male and female sex hormones – oestrogens and androgens.

Adrenal Medulla

  • The adrenal medulla is made up of chromaffin cells (hormone-producing cells) surrounding sinuses containing blood
  • These chromaffin cells are considered to be postganglionic cells specialised in secretion
  • Preganglionic fibres pass directly into the chromaffin cells of the gland within the adrenal medulla
  • Secretion of hormones is controlled by the autonomic nervous system and innervation by preganglionic fibres that allows rapid response to a stimulus by the gland

Epinephrine and Norepinephrine

The adrenal medulla synthesises the following two hormones:

  • Epinephrine (adrenaline)
  • Norepinephrine (noradrenaline)

Epinephrine is stronger than norepinephrine. It:

  • increases the blood pressure by increasing the heart rate and constricting the blood vessels
  • increases respiration rate
  • dilates respiratory passageways
  • decreases digestion rate
  • increases muscular contraction efficiency
  • increases blood sugar level
  • stimulates cellular metabolism

However, both epinephrine and norepinephrine:

  • mimic the sympathetic nervous system – they are sympathomimetic
  • help in stress resistance

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The Endocrine System – Pancreas Anatomy and Physiology

The pancreas, which is located in the curve of the duodenum, is a flat organ measuring between 12.5cm-15cm. It is a composite gland – both an exocrine and an endocrine gland: Exocrine acini secrete digestive enzymes into the duodenum, while the Islets of Langerhans help with carbohydrate metabolism.

pancreas anatomy and physiology
Retrieved from https://en.wikipedia.org/wiki/Pancreas on 7th March 2022

Pancreas Blood Supply

The Splenic Artery supplies the pancreas with blood, while venous return is completed through small veins within the Splenic Vein.

pancreas anatomy and physiology
Retrieved from https://epos.myesr.org/posterimage/esr/ecr2014/120564/mediagallery/539242?deliveroriginal=1 on 7th March 2022

Pancreas Nerve Supply

The Autonomic Nervous System (ANS) innervates the pancreas. Parasympathetic Vagal Fibres stimulate exocrine secretion, while Sympathetic Vasoconstrictor Impulses travel through nerves derived from spinal cord segments T6-T10 which pass through blood vessels within the pancreas. This reflects why pancreatic pain frequently radiates these nerve pathways.

pancreas anatomy and physiology
Retrieved from https://clinicalgate.com/thorax-2/ on 7th March 2022

The Endocrine Portion

The Islets of Langerhans contain 4 types of cells:

  1. Alpha Cells – make up 15% of the pancreatic islet cells; secrete Glucagon
  2. Beta Cells – make up 80% of the pancreatic islet cells; secrete Insulin
  3. Delta Cells – make up 5% of the pancreatic islet cells; secrete Somatostatin
  4. F Cells – secrete Pancreatic Polypeptide
Retrieved from https://slideplayer.com/slide/7426531/ on 7th March 2022
  • Glucagon INCREASES blood glucose level
  • Insulin DECREASES blood glucose level
  • Somatostatin INHIBITS insulin and glucagon, acting as a regulator
  • Pancreatic Polypeptide INHIBITS somatostatin secretion, gallbladder contraction, and digestive enzyme secretion (Pancreatic Polypeptide is secreted near the end of the digestive system)

Glucagon

The main function of glucagon is that of increasing blood glucose level. This is carried out through the following process:

  1. Glucagon increases glycogen conversion into glucose within the liver (glycogenolysis) AND increases nutrient (amino acids, glycerol and lactic acid) conversion into glucose within the liver (gluconeogenesis)
  2. Liver releases glucose into the blood, causing an increase in blood sugar level
  3. Blood sugar level controls secretion of glucagon through a negative feedback mechanism

lysis = breaking down of glycogen

neo = new

genesis = production

Secretion of glucagon is STIMULATED by:

  • decreased blood glucose level
  • protein-based foods
  • exercise

Secretion of glucagon is INHIBITED by:

  • somatostatin
  • insulin

Insulin

Islet beta cells produce insulin, which increases protein build-up within the cells. Insulin regulation is controlled by a negative feedback mechanism based on the blood sugar level.

Insulin decreases blood sugar level through the following process:

  1. increases glucose transportation from the blood into the cells
  2. increases glucose conversion into glycogen (glycogenesis)
  3. decreases glycogenolysis and gluconeogenesis
  4. stimulates glucose conversion to fatty acids
  5. stimulates protein synthesis

Secretion of insulin is STIMULATED by:

  • increased blood glucose level
  • acetylcholine (released by parasympathetic vagus nerve fibres)
  • amino acids (arginine and leucine)
  • growth hormone (GH) (which causes increase in blood sugar level)
  • ACTH (adrenocorticotropic hormone) (stimulates glucocorticoids secretion leading to hyperglycaemia, indirectly stimulating insulin release)

Secretion of insulin is INHIBITED by:

  • somatostatin (GIF – growth hormone inhibiting factor)

Insulin production is also AFFECTED by:

  • stomach and intestinal gastrin
  • secretin
  • cholecystokinin
  • gastric inhibitory peptide (GIP)

Insulin vs Glucagon

Somatostatin

Somatostatin is secreted by delta cells in the Islets of Langerhans following an increase in blood glucose, fatty acids, and amino acids due to an ingested meal. Somatostatin travels in the blood, slowing down the absorption of nutrients from the GIT, acting as paracrine secretion, diffusing into tissue fluid targeting nearby cells, and inhibiting both insulin and glucagon release from nearby alpha and beta cells.

Somatostatin secretion is INHIBITED by pancreatic polypeptide.

Pancreatic Polypeptide

Pancreatic Polypeptide inhibits secretion of somatostatin, gallbladder contraction, and secretion of pancreatic digestive enzymes.

Secretion of pacreatic polypeptide is STIMULATED by:

  • protein-containing meals
  • fasting
  • exercise
  • hypoglycaemia

Secretion of pancreatic polypeptide is INHIBITED by:

  • somatostatin
  • hyperglycaemia

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The Endocrine System – Hypothalamus & Pituitary Gland

The endocrine system is made up of hormone-producing glands within the body which facilitate communication between cells. Glands that make up the endocrine system include the hypothalamus, pituitary gland, and pineal gland, all of which can be found within the brain; the thyroid and parathyroid glands which can be found in the neck; the thymus which is situated between the lungs; the adrenals, which sit on the kidneys; the pancreas, which is found behind the stomach; and the ovaries (women) or testes (men) which are in the pelvic region.

endocrine system hypothalamus and pituitary gland
Retrieved from https://www.blendspace.com/lessons/tv-3ufAxEQI3pQ/group-3-307-313-331-endocrine-system on 3rd March 2022

Within the endocrine system, an endocrine gland or tissue releases an amount of hormone, which amount is determined by the body’s need for that hormone. Through sensing and signalling systems, hormone-producing cells receive information and regulate hormone release amount and duration. Released hormones are carried by the blood to target cells, which contain receptors that bind the hormone, leading to the desired effect. This effect is then recognised by secretory cells through a feedback signal. Once the required hormonal effect is fully accomplished, the hormones are either removed by the liver or the kidneys, or else degraded by the target cells.

Hormonal secretion is regulated by negative feedback control so homeostasis within the body is maintained.

The Hypothalamus

The hypothalamus, which is located below the thalamus, acts as a link between the nervous system and the endocrine system. It receives inputs from various parts of the brain, and sensory signals from internal organs and the retina. Changes are triggered in the hypothalamic activity due to pain, stress, and other emotional factors. The hypothalamus controls the autonomic nervous system and regulates various bodily factors such as temperature, hunger and thirst, sexual behaviour, and defensive reactions.

The Endocrine System - Hypothalamus & Pituitary Gland
Retrieved from https://kids.frontiersin.org/articles/10.3389/frym.2021.534184 on 3rd March 2022

Within the hypothalamus are clusters of specialised neurons – neurosecretory cells, which synthesise the hypothalamic hormones in their cell body. The hormones are transported inside vesicles by axonal transport.

Hypothalamus-Released Hormones

The hypothalamus is an important endocrine gland that produces hormones which, after being released into the blood, travel in the portal veins to a secondary capillary bed found in the anterior lobe of the pituitary, where their effects are produced. Hormones released in this way include:

  • Thyrotropin-releasing hormone (TRH) – related to thyroid gland growth and function
  • Gonadotropin-releasing hormone (GnRH) – related to the reproductive system
  • Growth hormone-releasing hormone (GHRH) – related to growth
  • Corticotropin-releasing hormone (CRH) – related to hormone secretion
  • Somatostatin – related to the growth hormone
  • Dopamine – acts as a neurotransmitter

Hormones which travel in the neurons to the posterior lobe of the pituitary before being released into circulation include:

  • Antidiuretic Hormone (ADH) / Vasopressin – promotes regulation of the amount of water within the body
  • Oxytocin – involved in childbirth and breastfeeding

The Pituitary Gland

The pituitary gland, which measures just about 1.3cm in diameter, is located in the cella turcica of the sphenoid bone. It is attached to the hypothalamus via the infundibulum – a stalklike structure. Pituitary gland hormones regulate body activities. The pituitary gland is divided into two lobes: the anterior lobe and the posterior lobe.

The pituitary gland anterior lobe accounts to around 80% of the pituitary gland. It is involved in growth regulation, metabolism, and reproduction, through its produced hormones. Hormone production happens through stimulation or inhibition by chemical messages originating from the hypothalamus. Thus, hypothalamic hormones act as a link between the nervous system and the endocrine system. They reach the anterior pituitary through the Hypophyseal Portal System.

The pituitary gland posterior lobe is involved in hormone transmission. Hormones originating from neurons within the region of the hypothalamus are secreted directly into peripheral circulation.

The lobes are divided by the pars intermedia – a relatively avascular zone.

The Endocrine System - Hypothalamus & Pituitary Gland
Retrieved from https://www.nature.com/articles/nrdp201692 on 5th March 2022

The 5 Types of Glandular Cells

  1. Somatotroph Cells – produce GH (growth hormone) which is responsible for general body growth
  2. Lactotroph Cells – synthesise PRL (prolactin) which promotes milk production by the mammary glands
  3. Corticolipothroph Cells – synthesise ACTH (adrenocorticotropic hormone) which stimulates hormone secretion, and MSH (melanocyte-stimulating hormone) which is responsible for skin pigmentation
  4. Thyrothroph Cells – produce TSH (thyroid-stimulating hormone), which controls the thyroid gland
  5. Gonadotroph Cells – produce FSH (follicle-stimulating hormone), which stimulates egg and sperm production in the ovaries and testes, and LH (luteinizing hormone), which stimulates other sexual and reproductive activities.
The Endocrine System - Hypothalamus & Pituitary Gland
Retrieved from http://www.pharmacy180.com/article/pituitary-gland-3595/ on 5th March 2022

Growth Hormone (GH)

  • is released through two regulating factors from the hypothalamus, namely GHRF (growth hormone releasing factor) and GHIF (growth hormone inhibiting factor) or Somatostatin
  • causes cells to grow and multiply by increasing the rate at which amino acids enter the cells to be built up into proteins
  • acts on the skeleton and the skeletal muscles firstly by increasing their growth rate, and then maintaining their size when growth is attained
  • increases the rate of protein synthesis a.k.a. protein anabolism
  • promotes fat catabolism by causing cells to change from burning carbohydrates to burning fats to produce energy
  • accelerates rate at which glycogen stored within the liver converts into glucose and releases itself into the blood
  • converts other factors into growth-promoting substances – somatomedins and insulin-like growth factors (IGF), both of which are similar to insulin yet more potent than insulin

Growth Hormone Secretion Stimuli and Inhibition

Retrieved from https://basicmedicalkey.com/normal-endocrine-function/ on 5th March 2022

Prolactin (PRL)

  • requires priming of the mammary glands through oestrogens, progesterone, corticosteroids, growth hormone, thyroxine, and insulin
  • initiates and maintains milk secretion by the mammary glands (amount of milk is determined by oxytocin)
  • has an inhibitory and an excitatory negative control system
  • level rises during pregnancy, falls right after delivery, and rises again during breastfeeding, which is why in the 1st two days following birth, mothers do not produce milk but colostrum

NOTE: women on oral contraceptives may experience lack of milk production due to their hormonal effect.

Melanocyte-Stimulating Hormone (MSH)

  • increases skin pigmentation through the stimulation of melanin granules dispersion in melanocytes
  • secretion is stimulated by the melanocyte-stimulating hormone releasing factor (MRF), or inhibited by the melanocyte-stimulating hormone inhibiting factor (MIF)
  • lack causes the skin to look pallid
  • excess causes the skin to look dark

Thyroid-stimulating factor (TSH)

  • stimulates the synthesis and secretion of hormonal production within the thyroid gland
  • secretion is controlled by the thyrotropin releasing factor (TRF), which is released based on thyroxine blood level, metabolic rate of the body, and other factors through a negative feedback system

Adrenocorticotropic Hormone (ACTH)

  • controls the production and secretion of some adrenal cortex hormones
  • is secreted by the hypothalamic regulating factor called corticotropin releasing factor (CRF), which is released depending on stimuli and hormones through a negative feedback system

Follicle-Stimulating Hormone (FSH)

  • in females initiates the development of an ova every month, and stimulates cells within the ovaries to secrete oestrogens
  • in males stimulates the testes to produce sperm
  • secretion depends on the hypothalamic regulating factor gonadotropin releasing factor (GnRF), which is released in response to oestrogens in females, and to testosterone in males through a negative feedback system

Luteinizing Hormone (LH)

  • along with oestrogens, in females it stimulates the release of an ovum within the ovary, prepares the uterus for the implantation of the fertilised ovum, stimulates the formation of the corpus luteum in the ovary to secrete progesterone, and prepares the mammary glands for milk secretion
  • in males it stimulates the interstitial endocrinocytes in the testes to develop and secrete testosterone
  • secretion is controlled by GnRF, which works through a negative feedback system

Pituitary Gland Posterior Lobe

The posterior lobe of the pituitary gland a.k.a. neurohypophysis, does not synthesise hormones. It releases hormones to the circulation via the posterior hypophyseal veins to be distributed to target cells in other tissues. The cell bodies of the neurosecretory cells produce Oxytocin (OT) and Antidiuretic Hormone (ADH) / Vasopressin.

Oxytocin (OT)

  • is released in high amounts just before birth
  • stimulates contraction of smooth muscle cells in the pregnant uterus
  • stimulates the contractile cells around the mammary gland ducts
  • affects milk ejection
  • works through a positive feedback cycle which is broken following birthing
  • is inhibited by progesterone, but can work in conjunction to oestrogens

Antidiuretic hormone (ADH)

  • affects urine volume; it causes the kidneys to excrete water from fresh urine and return it to the bloodstream, reducing urine volume
  • absence causes an increase in urine output
  • raises blood pressure by constricting arterioles
  • secretion varies based on the body’s needs
  • causes a decrease in sweat
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