Adrenal Cortex and Glucocorticoid ‘Synthesis ‘The mineratocortico(steroyas aldosterone, conicostrone and M-desonycoricoterone (pp teat and 208) are synthesized in the ‘Somerularzone ofthe adrenal cortex» At) whereas the glucocortico(steroyids cordsol (lydrocorisone) and comsone (-+ p.254, small quanuies) are synthesized inthe fascc- ular zone (—» A2). Androgens are synthesized inthe relafar zane ofthe adrenal comex (-» 3), One of the androgens is defy croepan- roxerone (DHEA) which used (party an its sulfated form, DHEA-S) to synthesize various Sex hormones in other tissues (-» p.304). ‘cotizo transport. Mastf the plasms cont ‘sol is bound co mranscoram, or corrésal-bindling ‘dlobuim (CBG) a specie anspor: protein ‘vith a high-afniy binding site for corusol Corusol is released in response 1o confor- mauonal changes af CBG due to inflammation (CRM and ACTH regulate consol synthesis and secretion (+ A, AS; see alsop. 270). ACTH also stucmiral preservation of the ‘ptenal cortex and supplies cortisol precur- Sor. eg. ty forming choleseral fom its esters, by de nave synthesis of cholesterol and by corwersing ic progesterone and T7a-by- Aroxyprogesterone (--pp.256and 293), ACTH secretion is stimulated by CRH and epineph- ‘Tine and inhibited (negative feedback control) by cordsolwichorwithout che aid of CH (-+ A, see a0 p.273A) 1nd gt of RH section and ths of ‘ACTH and coral secretion canbe cand. The (peak secretion is in the maening (-- B mean values). Clsthnones hermoee cose spn ef or incr telshave down at ACT andar resected ‘in 2-3-hour qpitoder (+B). Receptor protetns (+ .278) for glucocont- coud canbe fund in virtually every cell it~ cocuricoids are vital hormones that exert ‘numerous effects he most importance of ‘which are ksted Below (Carbohydrate and amano 2c (AA) mstabo- ism (see also pp.283A and 285C): Cortisol tte AA derived ffom protin degradation 0 sncreaze the plasma glucose concenation (gluconeogenesis), which can lead w the so- ‘called steromd diaberes in extreme cases. Thus, ‘cortisol has a carabolie effect (degrades prov reins) that results in the increased excretion of ‘urea, Cardiovascular function: Glucocorticoids increase myocardial contractility and vasocon- smicton due wo enhancement of cate ‘cholamine effects (_-pp. 194 and 214). These are described as permissive effec of cortisol. ‘Cartsal increases the synthesis of epinephrine ‘nthe adrenal medulla (—-A6)and of angiocen- sinagen én the liver (+p. 184) stabilize lymphokine synthesis and histamine release (+ _100). On the other hand, inter- leulun-1, incerleukin-2 and THEa (eg, in severe infection) leads vo increased secretion ‘of CRH and high cortisol cone (see below). Renal function: Quccortcsd delay the exretion (rte andbelp taraintsin a normal garmenr Fl- {ation rate. They ean react alsowahalgonterone re ‘ceptors but are coewerted to cortzone by 11fbie royteaid cviereductme in aldosterone target ‘eels Normal cortisol conc. are thetslore ieee (3 the sdorterone recepene. High conc., however, ‘have the same ellct s:aldeaterone (+p 182). Gastric Function: Glucocorticoids weaken the protective mechariams of the gusric mucosa. Tha, high-dose glucocorticoid or sexe (cee Below) in ‘eeate the rth of get uoers (+p 242). Cerebral function: High glucoearticid conc. ‘change typothalamic (+) and electrical brain a= tity (EEG) and lead to paychic abnormalities. ‘Stress: Physical or mental stress increases car- tisal secretion as a result of increased CRH secretion and increased sympathetic one (+A). Many of the aforementioned effects of ‘comttsol therefore play 2 role in the body's re sponse to stress (activation of energy metabo- lism, increase in cardiac performance, etc.) tn severe physical (eg. sepsis) oF mental stress (eg, depression), the cortisol plasma conc. re- mains at avery high level (up vo 10 times the ‘normal value) thraughour the day. Rasnanevilns Cain diss af Pharsininen 1 2092 Thiame