CLASSIFICATION & STRUCTURE
The hormones of the adrenal cortex are derivatives of cholesterol. Like cholesterol, bile acids, vitamin D, and ovarian and testicular steroids, they contain the cyclopentanoperhydrophenanthrene nucleus (Figure 20–6). Gonadal and adrenocortical steroids are of three types: C21 steroids, which have a two-carbon side chain at position 17; C19 steroids, which have a keto or hydroxyl group at position 17; and C18 steroids, which, in addition to a 17-keto or hydroxyl group, have no angular methyl group attached to position 10. The adrenal cortex secretes primarily C21 and C19 steroids. Most of the C19 steroids have a keto group at position 17 and are therefore called 17-ketosteroids. The C21 steroids that have a hydroxyl group at the 17 position in addition to the side chain are often called 17-hydroxycorticoids or 17-hydroxycorticosteroids.
Basic structure of adrenocortical and gonadal steroids. The letters in the formula for cholesterol identify the four basic rings, and the numbers identify the positions in the molecule. As shown here, the angular methyl groups (positions 18 and 19) are usually indicated simply by straight lines.
The C19 steroids have androgenic activity. The C21 steroids are classified, using Selye’s terminology, as mineralocorticoids or glucocorticoids. All secreted C21 steroids have both mineralocorticoid and glucocorticoid activity; mineralocorticoids are those in which effects on Na+ and K+ excretion predominate and glucocorticoids are those in which effects on glucose and protein metabolism predominate.
The details of steroid nomenclature and isomerism can be found elsewhere. However, it is pertinent to mention that the Greek letter Δ indicates a double bond and that the groups that lie above the plane of each of the steroid rings are indicated by the Greek letter β and a solid line (—OH), whereas those that lie below the plane are indicated by α and a dashed line (- - -OH). Thus, the C21 steroids secreted by the adrenal have a Δ4-3-keto configuration in the A ring. In most naturally occurring adrenal steroids, 17-hydroxy groups are in the α configuration, whereas 3-, 11-, and 21-hydroxy groups are in the β configuration. The 18-aldehyde configuration of naturally occurring aldosterone is the D form. L-aldosterone is physiologically inactive.
Innumerable steroids have been isolated from adrenal tissue, but the only steroids normally secreted in physiologically significant amounts are the mineralocorticoid aldosterone, the glucocorticoids cortisol and corticosterone, and the androgens dehydroepiandrosterone (DHEA) and androstenedione. The structures of these steroids are shown in Figure 20–7 and Figure 20–8. Deoxycorticosterone is a mineralocorticoid that is normally secreted in about the same amount as aldosterone (Table 20–1) but has only 3% of the mineralocorticoid activity of aldosterone. Its effect on mineral metabolism is usually negligible, but in diseases in which its secretion is increased, its effect can be appreciable. Most of the estrogens that are not formed in the ovaries are produced in the circulation from adrenal androstenedione. Almost all the dehydroepiandrosterone is secreted conjugated with sulfate, although most if not all of the other steroids are secreted in the free, unconjugated form (Clinical Box 20–1).
TABLE 20–1Principal adrenocortical hormones in adult humans.a ||Download (.pdf) TABLE 20–1 Principal adrenocortical hormones in adult humans.a
|Name ||Synonyms ||Average Plasma Concentration (Free and Bound)a μg/dL) ||Average Amount Secreted (mg/24 h) |
|Cortisol ||Compound F, hydrocortisone ||13.9 ||10 |
|Corticosterone ||Compound B ||0.4 ||3 |
|Aldosterone || ||0.0006 ||0.15 |
|Deoxycorticosterone ||DOC ||0.0006 ||0.20 |
|Dehydroepiandrosterone sulfate ||DHEAS ||175.0 ||20 |
Outline of hormone biosynthesis in the zona fasciculata and zona reticularis of the adrenal cortex. The major secretory products are underlined. The enzymes for the reactions are shown on the left and at the top of the chart. When a particular enzyme is deficient, hormone production is blocked at the points indicated by the shaded bars.
Hormone synthesis in the zona glomerulosa. The zona glomerulosa lacks 17α-hydroxylase activity, and only the zona glomerulosa can convert corticosterone to aldosterone because it is the only zone that normally contains aldosterone synthase. ANG II, angiotensin II.
In all species from amphibia to humans, the major C21 steroid hormones secreted by adrenocortical tissue appear to be aldosterone, cortisol, and corticosterone, although the ratio of cortisol to corticosterone varies. Birds, mice, and rats secrete corticosterone almost exclusively; dogs secrete approximately equal amounts of the two glucocorticoids; and cats, sheep, monkeys, and humans secrete predominantly cortisol. In humans, the ratio of secreted cortisol to corticosterone is approximately 7:1.
The major paths by which the naturally occurring adrenocortical hormones are synthesized in the body are summarized in Figures 20–7 and 20–8. The precursor of all steroids is cholesterol. Some of the cholesterol is synthesized from acetate, but most of it is taken up from LDL in the circulation. LDL receptors are especially abundant in adrenocortical cells. The cholesterol is esterified and stored in lipid droplets. Cholesterol ester hydrolase catalyzes the formation of free cholesterol in the lipid droplets (Figure 20–9). The cholesterol is transported to mitochondria by a sterol carrier protein. In the mitochondria, it is converted to pregnenolone in a reaction catalyzed by an enzyme known as cholesterol desmolase or side-chain cleavage enzyme. This enzyme, like most of the enzymes involved in steroid biosynthesis, is a member of the cytochrome P450 superfamily and is also known as P450scc or CYP11A1. For convenience, the various names of the enzymes involved in adrenocortical steroid biosynthesis are summarized in Table 20–3.
Mechanism of action of ACTH on cortisol-secreting cells in the inner two zones of the adrenal cortex. When ACTH binds to its receptor (R), adenylyl cyclase (AC) is activated via Gs. The resulting increase in cAMP activates protein kinase A, and the kinase phosphorylates cholesteryl ester hydrolase (CEH), increasing its activity. Consequently, more free cholesterol is formed and converted to pregnenolone. Note that in the subsequent steps in steroid biosynthesis, products are shuttled between the mitochondria and the smooth endoplasmic reticulum (SER). Corticosterone is also synthesized and secreted.
CLINICAL BOX 20–1 Synthetic Steroids
As with many other naturally occurring substances, the activity of adrenocortical steroids can be increased by altering their structure. A number of synthetic steroids are available that have many times the activity of cortisol. The relative glucocorticoid and mineralocorticoid potencies of the natural steroids are compared with those of the synthetic steroids 9α-fluorocortisol, prednisolone, and dexamethasone in Table 20–2. The potency of dexamethasone is due to its high affinity for glucocorticoid receptors and its long half-life. Prednisolone also has a long half-life.
TABLE 20–2Relative potencies of corticosteroids compared with cortisol.a ||Download (.pdf) TABLE 20–2 Relative potencies of corticosteroids compared with cortisol.a
|Steroid ||Glucocorticoid Activity ||Mineralocorticoid Activity |
|Cortisol ||1.0 ||1.0 |
|Corticosterone ||0.3 ||15 |
|Aldosterone ||0.3 ||3000 |
|Deoxycorticosterone ||0.2 ||100 |
|Costisone ||0.7 ||0.8 |
|Prednisolone ||4 ||0.8 |
|9α-Fluorocortisol ||10 ||125 |
|Dexamethasone ||25 ||–0 |
TABLE 20–3Nomenclature for adrenal steroidogenic enzymes and their location in adrenal cells. ||Download (.pdf) TABLE 20–3 Nomenclature for adrenal steroidogenic enzymes and their location in adrenal cells.
|Trivial Name ||P450 ||CYP ||Location |
|Cholesterol desmolase; side-chain cleavage enzyme ||P450SCC ||CYP11A1 ||Mitochondria |
|3β-Hydroxysteroid dehydrogenase ||… ||… ||SER |
|17α-Hydroxylase, 17,20-lyase ||P450C17 ||CYP17 ||Mitochondria |
|21β-Hydroxylase ||P450C21 ||CYP21A2 ||SER |
|11β-Hydroxylase ||P450C11 ||CYP11B1 ||Mitochondria |
|Aldosterone synthase ||P450C11AS ||CYP11B2 ||Mitochondria |
Pregnenolone moves to the smooth endoplasmic reticulum, where some of it is dehydrogenated to form progesterone in a reaction catalyzed by 3β-hydroxysteroid dehydrogenase. This enzyme has a molecular weight of 46,000 and is not a cytochrome P450. It also catalyzes the conversion of 17α-hydroxypregnenolone to 17α-hydroxyprogesterone, and dehydroepiandrosterone to androstenedione (Figure 22–7) in the smooth endoplasmic reticulum. The 17α-hydroxypregnenolone and the 17α-hydroxyprogesterone are formed from pregnenolone and progesterone, respectively (Figure 20–7) by the action of 17α-hydroxylase. This is another mitochondrial P450, and it is also known as P450c17 or CYP17. Located in another part of the same enzyme is 17,20-lyase activity that breaks the 17,20 bond, converting 17α-pregnenolone and 17α-progesterone to the C19 steroids dehydroepiandrosterone and androstenedione.
Hydroxylation of progesterone to 11-deoxycorticosterone and of 17α-hydroxyprogesterone to 11-deoxycortisol occurs in the smooth endoplasmic reticulum. These reactions are catalyzed by 21β-hydroxylase, a cytochrome P450 that is also known as P450c21 or CYP21A2.
11-Deoxycorticosterone and the 11-deoxycortisol move back to the mitochondria, where they are 11-hydroxylated to form corticosterone and cortisol. These reactions occur in the zona fasciculata and zona reticularis and are catalyzed by 11β-hydroxylase, a cytochrome P450 also known as P450c11 or CYP11B1.
In the zona glomerulosa there is no 11β-hydroxylase, but a closely related enzyme called aldosterone synthase is present. This cytochrome P450 is 95% identical to 11β-hydroxylase and is also known as P450c11AS or CYP11B2. The genes that code CYP11B1 and CYP11B2 are both located on chromosome 8. However, aldosterone synthase is normally found only in the zona glomerulosa. The zona glomerulosa also lacks 17α-hydroxylase. This is why the zona glomerulosa makes aldosterone but fails to make cortisol or sex hormones.
Furthermore, subspecialization occurs within the inner two zones. The zona fasciculata has more 3β-hydroxysteroid dehydrogenase activity than the zona reticularis, and the zona reticularis has more of the cofactors required for the 17,20-lyase activity of 17α-hydroxylase. Therefore, the zona fasciculata makes more cortisol and corticosterone, and the zona reticularis makes more androgens. Most of the dehydroepiandrosterone that is formed is converted to dehydroepiandrosterone sulfate (DHEAS) by adrenal sulfokinase, and this enzyme is localized in the zona reticularis as well.
ACTH binds to high-affinity receptors on the plasma membrane of adrenocortical cells. This activates adenylyl cyclase via Gs. The resulting reactions (Figure 20–9) lead to a prompt increase in the formation of pregnenolone and its derivatives, with secretion of the latter. Over longer periods, ACTH also increases the synthesis of the P450s involved in the synthesis of glucocorticoids.
ACTIONS OF ANGIOTENSIN II
Angiotensin II binds to AT1 receptors (see Chapter 38) in the zona glomerulosa that act via a G-protein to activate phospholipase C. The resulting increase in protein kinase C fosters the conversion of cholesterol to pregnenolone (Figure 20–8) and facilitates the action of aldosterone synthase, resulting in increased secretion of aldosterone.
The consequences of inhibiting any of the enzyme systems involved in steroid biosynthesis can be predicted from Figures 20–7 and 20–8. Congenital defects in the enzymes lead to deficient cortisol secretion and the syndrome of congenital adrenal hyperplasia. The hyperplasia is due to increased ACTH secretion. Cholesterol desmolase deficiency is fatal in utero because it prevents the placenta from making the progesterone necessary for pregnancy to continue. A cause of severe congenital adrenal hyperplasia in newborns is a loss of function mutation of the gene for the steroidogenic acute regulatory (StAR) protein. This protein is essential in the adrenals and gonads but not in the placenta for the normal movement of cholesterol into the mitochondria to reach cholesterol desmolase, which is located on the matrix space side of the internal mitochondrial membrane (see Chapter 16). In its absence, only small amounts of steroids are formed. The degree of ACTH stimulation is marked, resulting eventually in accumulation of large numbers of lipoid droplets in the adrenal. For this reason, the condition is called congenital lipoid adrenal hyperplasia. Because androgens are not formed, female genitalia develop regardless of genetic sex (see Chapter 22). In 3β hydroxysteroid dehydrogenase deficiency, another rare condition, DHEA secretion is increased. This steroid is a weak androgen that can cause some masculinization in females with the disease, but it is not adequate to produce full masculinization of the genitalia in genetic males. Consequently, hypospadias, a condition where the opening of the urethra is on the underside of the penis rather than its tip, is common. In fully developed 17α-hydroxylase deficiency, a third rare condition due to a mutated gene for CYP17, no sex hormones are produced, so female external genitalia are present. However, the pathway leading to corticosterone and aldosterone is intact, and elevated levels of 11-deoxycorticosterone and other mineralocorticoids produce hypertension and hypokalemia. Cortisol is deficient, but this is partially compensated by the glucocorticoid activity of corticosterone.
Unlike the defects discussed in the preceding paragraph, 21β-hydroxylase deficiency is common, accounting for 90% or more of the enzyme deficiency cases. The 21β-hydroxylase gene, which is in the HLA complex of genes on the short arm of chromosome 6 (see Chapter 3) is one of the most polymorphic in the human genome. Mutations occur at many different sites in the gene, and the abnormalities that are produced therefore range from mild to severe. Production of cortisol and aldosterone are generally reduced, so ACTH secretion and consequently production of precursor steroids are increased. These steroids are converted to androgens, producing virilization. The characteristic pattern that develops in females in the absence of treatment is the adrenogenital syndrome. Masculization may not be marked until later in life and mild cases can be detected only by laboratory tests. In 75% of the cases, aldosterone deficiency causes appreciable loss of Na+ (salt-losing form of adrenal hyperplasia). The resulting hypovolemia can be severe.
In 11β-hydroxylase deficiency, virilization plus excess secretion of 11-deoxycortisol and 11-deoxycorticosterone take place. Because the former is an active mineralocorticoid, patients with this condition also have salt and water retention and, in two-thirds of the cases, hypertension (hypertensive form of congenital adrenal hyperplasia).
Glucocorticoid treatment is indicated in all of the virilizing forms of congenital adrenal hyperplasia because it repairs the glucocorticoid deficit and inhibits ACTH secretion, reducing the abnormal secretion of androgens and other steroids.
Expression of the cytochrome P450 enzymes responsible for steroid hormone biosynthesis depends on steroid factor-1 (SF-1), an orphan nuclear receptor. If Ft2-F1, the gene for SF-1, is knocked out, the gonads as well as adrenals fail to develop and additional abnormalities are present at the pituitary and hypothalamic level.