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ORGANIZATION OF CLASS

Now would be a good time to do a quick review of the anatomy of the adrenal gland and the normal release of cortisol and aldosterone. Remember that the adrenal medulla produces epinephrine and norepinephrine. Within the adrenal cortex, there are three layers. The zona glomerulosa (outer layer) produces the compounds that control electrolyte balance, such as aldosterone. The zona fasciculata (middle layer) produces the compounds that regulate metabolism, such as hydrocortisone. The zona reticularis (inner layer) produces the sex hormones (see Chapter 39). The pituitary hormone adrenocorticotropic hormone (ACTH) controls the secretion of, primarily, the inner two layers. The production of mineralocorticoids is mainly controlled by the renin-angiotensin system.

Deficiency of the adrenocortical hormones results in the signs and symptoms of Addison disease. Excess production causes Cushing syndrome. Both natural and synthetic corticosteroids are used to diagnose and treat disorders of adrenal function and treat a variety of inflammatory and immunologic disorders.

The term steroid relates to the main structural frame of this series of compounds (Figure 38–1).

FIGURE 38–1

The main steroid structure is shown, along with two examples of adrenocortical hormones.

The steroid compounds produced by the adrenal cortex are called adrenocorticosteroids, and they can be divided into two main groups depending on their relative metabolic (glucocorticoid) versus electrolyte-regulating (mineralocorticoid) activity. Of course, each compound has effects on both metabolism and electrolyte balance, but one effect is usually more potent than the other. Almost every cell in the body will respond to these compounds.

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Glucocorticoid Equal Potency Mineralocorticoid

DEXAMETHASONE

PREDNISONE

fluticasone

betamethasone

methylprednisolone

prednisolone

triamcinolone

cortisol

hydrocortisone

fludrocortisone

Compare this list of drugs with the list in your textbook or class handouts and make any necessary changes. I have found lists of more than 20 glucocorticoids, so the table above is quite abbreviated. You may also find a list dividing the drugs into short, intermediate, and long acting. This is useful information to add if you have time.

Hydrocortisone (cortisol) is the main glucocorticoid, and aldosterone is the main mineralocorticoid produced by the adrenal glands. Notice that hydrocortisone and its close relative, cortisol, are the only two drugs that have equal metabolic (glucocorticoid) and electrolyte balance (mineralocorticoid) actions. Remember this. Next, notice that there are many more drugs listed on the left (glucocorticoid) than on the right (mineralocorticoid). Therefore, if you have to guess about the activity of a drug, guess glucocorticoid. Better yet, just learn the mineralocorticoid drug on the right (it starts with “f,” but it’s not the only one that does).

The pharmacologic actions of steroids are an extension of their physiological effects.

This should seem self-evident, but sometimes it is forgotten.

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