The Adrenal Gland: Common Disease States and Suspected New Applications

Linda S. Gorman

doi:10.29074/ascls.26.2.118

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Linda S. Gorman, PhD, MLS (ASCP)^CM⇑
1. University of Kentucky, Lexington, KY

Address for Correspondence: Linda S. Gorman, PhD, MLS (ASCP)^CM, CLS Education Co-ordinator, Associate Professor, 900 S. Limestone Ave, Rm 126G CTW, University of Kentucky, Lexington, KY 40536-0200, (859)-218-0855, lsgorm0{at}uky.edu

Explain the renin-angiotensin-aldosterone mechanism and how it maintains blood pressure.
Describe the present laboratory findings for a soldier suffering from Post Traumatic Stress Disorder (PTSD).
Characterize how we differentiate between the various forms of Cushing's syndrome and the testing that makes that possible.
Describe the symptoms and laboratory findings for a patient with Addison's disease.
Characterize how we deduce a finding of pheochromocytoma in a patient.

Extract

This article covers the physiology of the adrenal gland as well as the common disease states. Post-traumatic stress disorder is discussed in relation to the possible role of the adrenal gland hormones and this disorder. Laboratory testing used to diagnose adrenal disorders is briefly described using reference laboratory methods.

Historically, the adrenal gland was thought to be “excess renal” tissue and not significant by anatomist Batholemeus Eustachius (1520-1574).¹ In the early 1800's, Culver (1769-1832) was the first to recognize the difference between the outer layer of the adrenal gland and the inner central core. It would not be until 1836 before N. Nagel termed these as “cortical” for the outer layer and “medulla” for the inner layer. Definitive descriptions of the adrenal gland awaited the microscopic anatomical examination by R. A. Von Kolliker (1817-1905). He described his findings as “the cortical and medullary substances are physiologically distinct and have different functions.”

The adrenal gland is viewed as a pyramid-shaped gland that is positioned above each kidney within the human body (Figure 1). This gland can be divided into the cortex and medulla regions, with the cortex producing steroid type hormones and the medulla producing neuropeptide type hormones. Embryonic development of the cortex comes from mesothelium adjacent to the dorsal mesentery.² The adrenal cortex differentiates into 3 zones- the glomerulosa, fasiculata and reticularis. Development of the adrenal cortex leads to the zona glomerulosa and zona fasiculata being present at birth with the zona reticularis presence delayed until the 3rd year after…

ABBREVIATIONS: ACTH - adrenocorticotropic hormone; ACE - angiotensin converting enzyme; ARR - aldosterone-renin ratio; CAH - congenital adrenal hyperplasia; CRH - corticotropin releasing hormone; CT - computerized axial tomography; DHEA – dehydroepiandrosterone; 11-DOC - 11-deoxycorticosterone; GR - glucocorticoid receptor; HPLC-high pressure liquid chromatography; HIV - human immunodeficiency virus; LC/MS-MS - liquid chromategraphy/mass spectroscopy-mass spectrophotometry; MRI - magnetic resonance imaging; MS - mass spectroscopy; PTSD - post-traumatic stress disorder; RIA - radio-immunoassay; TB - tuberculosis; SRE - steroid response element; VMA - vanillylmandelic acid

Explain the renin-angiotensin-aldosterone mechanism and how it maintains blood pressure.
Describe the present laboratory findings for a soldier suffering from Post Traumatic Stress Disorder (PTSD).
Characterize how we differentiate between the various forms of Cushing's syndrome and the testing that makes that possible.
Describe the symptoms and laboratory findings for a patient with Addison's disease.
Characterize how we deduce a finding of pheochromocytoma in a patient.