5 - Adrenal Glands (Adrenocorticoids)

ENDOCRINE GLAND
PHARMACOLOGY
• The endocrine system helps to maintain internal
homeostasis through the use of endogenous
chemicals known as hormones.
• A hormone is typically regarded as a chemical
messenger that is released into the bloodstream
to exert an effect on target cells located some
distance from the hormonal release site.
• Endocrine glands release specific hormones that
help regulate physiologic processes such as
reproduction, growth and development, energy
metabolism, fluid and electrolyte balance, and
response to stress and injury.
• The use of drugs to help regulate and control
endocrine function is an important area of
pharmacology. In one sense, hormones can
be considered drugs that are manufactured
by the patient’s body.
• Drugs can be used as replacement therapy
during hormonal deficiency
• Insulin administration in diabetes mellitus.
• Glucocorticoids to help treat inflammation.
• The use of antithyroid drugs in treating
• The outer zona Glomerulosa produces
mineralocorticoids (aldosterone) that are responsible
for regulating salt and water metabolism. Production of
aldosterone is regulated primarily by the renin–
angiotensin system.
• The middle zona Fasciculata synthesizes glucocorticoids
(cortisol) that are involved with metabolism and
response to stress.
• The inner zona Reticularis secretes adrenal androgens .
• Secretion by the two inner zones and, to a lesser extent,
the outer zone is controlled by pituitary
adrenocorticotropic hormone . which is released in
response to hypothalamic corticotropin-releasing
hormone (CRH). Glucocorticoids serve as feedback
inhibitors of ACTH and CRH secretion.
• Glucocorticoids favor Gluconeogenesis through
increasing amino acid uptake by the liver and kidney .
They stimulate protein catabolism .
• By raising plasma glucose levels, glucocorticoids
provide the body with energy to combat stress
caused by trauma, fright, infection, bleeding, or
debilitating disease.
• Potent Anti-Inflammatory and immunosuppressive
activities. The lowering of circulating lymphocytes is
known to play a role. Glucocorticoids also decrease
the production and release of proinflammato y
cytokines. They inhibit phospholipase A2 , which
blocks the release of arachidonic acid (the precursor
of the prostaglandins and leukotrienes)
• Aldosterone acts on distal tubules and collecting
ducts in the kidney, causing reabsorption of
sodium, bicarbonate, and water. Conversely,
aldosterone decreases reabsorption of
potassium.
• Isturisa is a medicine used to treat adults with
Cushing's syndrome, a disease characterised by an
excess production of the hormone cortisol.
• Dexamethasone is a synthetic steroid similar to
cortisol, which suppresses ACTH secretion in
normal people. Therefore, giving dexamethasone
should reduce ACTH levels.
• Ketoconazole - Ketoconazole is an
antifungal agent that strongly inhibits all
gonadal and adrenal steroid hormone
synthesis. It is used in the treatment of
patients with Cushing syndrome
• Mitotane and Metyrapone
• Elevated aldosterone levels may cause alkalosis
and hypokalemia, retention of sodium and water,
and increased blood volume and blood pressure.
• Hyperaldosteronism is treated with

Spironolactone - This antihypertensive drug
competes for the mineralocorticoid receptor and,
thus, inhibits sodium reabsorption in the kidney.
• Eplerenone - specifically binds to the
mineralocorticoid receptor, where it acts as an
aldosterone antagonist.
• Replacement therapy for primary
adrenocortical insufficiency (Addison disease):
• Addison disease is caused by adrenal cortex

dysfunction (as diagnosed by the lack of response to
ACTH administration).
• Hydrocortisone, which is identical to natural cortisol,
is given to correct the deficiency. Failure to do results
in death.
• Administration of Fludrocortisone a potent synthetic
mineralocorticoid with some glucocorticoid activity,
• Replacement therapy for secondary
or tertiary adrenocortical insufficieny:
• These disorders are caused by a defect in CRH

production by the hypothalamus or in ACTH
production by the pituitary.
• Hydrocortisone is used for treatment of these
deficiencies .
• Congenital Adrenal Hyperplasia (CAH):
• CAH is a group of diseases resulting from an enzyme
defect in the synthesis of one or more of the adrenal
steroid hormones. CAH may lead to Virilization in females
due to overproduction of adrenal androgens.
• Congenital adrenal hyperplasia is seen in infancy and
childhood. Because cortisol synthesis is decreased,
feedback inhibition of adrenocorticotropic hormone
(ACTH) formation and release is also decreased, resulting
in enhanced ACTH formation. This in turn leads to
increased levels of adrenal androgens and/or
mineralocorticoids. The treatment is to administer a
glucocorticoid, such as hydrocortisone (in infants) or
prednisone, which would restore the feedback inhibition
ADVERSE EFFECTS OF CORTICOIDS
• Osteoporosis is the most common adverse effect due
to the ability of glucocorticoids to suppress intestinal
Ca2+ absorption, inhibit bone formation.
• Bisphosphonates may also be useful in the treatment
of glucocorticoid-induced osteoporosis.
• The classic Cushing-like syndrome (redistribution of
body fat, puffy face, hirsutism, and increased appetite)
is observed in excess corticosteroid replacement.
• Cataracts & glaucoma may also occur with long-term
corticosteroid therapy.
• Hyperglycemia may develop and lead to diabetes
mellitus.

5 - Adrenal Glands (Adrenocorticoids)

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ENDOCRINE GLAND

• Hyperaldosteronism is treated with

• Addison disease is caused by adrenal cortex

• These disorders are caused by a defect in CRH

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