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The Adrenal Glands Suprarenal Glands And Their Products

Embedded in the fat above each kidney is an adrenal (suprarenal) gland. Both adrenal glands have an external portion and an internal portion. The external portion of the adrenal gland is called the cortex, while the internal portion of the gland is called the medulla. Both the cortex and the medulla produce specific hormones that are essential to the proper functioning of the body. As you will recall (Lesson 6, para 6-10a), the medulla produces epinephrine and norepinephrine. Epinephrine and norepinephrine are involved in the mobilization of energy during the stress reaction ( fight or flight response). The cortex also produces hormones that are essential to the body. These hormones are introduced below.

Adrenal Glands

To image the adrenal gland, direct contact of the probe with the adrenal gland is needed. The adrenal gland is found superior to the kidney. The probe is placed in a position directly in line with the superior pole of the kidney. Both angulation and small transverse movement establishes the tumor extent over the adrenal gland. The adrenal vein is found inferiorly from the lateral or posterior vena cava. The advantage of LUS for adrenal vein localization is in identifying this structure among the retroperitoneal fat. LUS of the adrenal gland can help distinquish the extent of tumor. Using LUS, dissection of the adrenal gland is less difficult. The extent of tumor is imaged with LUS. This imaging is helpful for pheochromocytomas also. Clipping of the adrenal vein may be done with LUS guidance. This technique is especially useful for clipping the left adrenal vein.

The Adrenal Glands

The adrenal glands (also known as suprarenal glands) are embedded in the fat above each kidney. Both adrenal glands have an internal medulla and an external cortex. a. Hormones of the Adrenal Medulla. The medullary (inside the gland) portion of each adrenal gland produces a pair of hormones, epinephrine (adrenalin) and norepinephrine (noradrenalin). These hormones are both involved in the mobilization of energy during the stress reaction ( fight or flight response). These hormones are also produced in the autonomic nervous system. Therefore, production of these hormones in the adrenal medulla is not necessary for life. After production, these hormones are stored in the adrenal medulla and are released in large quantities during the stress reaction. b. Hormones of the Suprarenal Cortex (Outside Area). Approximately 28 hormones are produced by the suprarenal cortex. These hormones are produced only in the suprarenal cortex and are essential to life. The hormones of the suprerenal cortex...

Neurohormonal Activation

In HF, norepinephrine is chronically elevated due to an increase in release and spillover from the adrenal gland, decreased plasma clearance, and decreased neuronal and non-neuronal reuptake. Norepinephrine increases afterload, causes cardiac arrhythmias, and has a direct toxic effect on the myocardium. There is a direct correlation between nor-epinephrine levels and both the hemodynamic severity and the poor prognosis of HF.6

Review Of Preclinical Data 521 Studies on Animals

In the subacute studies, male rats were given Ayush-64 500 mg kg suspension in distilled water orally for 12 weeks. This exposure did not produce any significant difference in body weight or food and water intake. Blood glucose, blood urea, serum cholesterol, AST and ALT, and urine analysis matched normal controls. Heart, spleen, kidney, and adrenals remained normal, and there was no evidence of gastric ulceration. There was no change in the wet weight of various organs, except the liver, for which a significant increase was noted. There was a mild increase in the total white blood cell (WBC) count. Ayush-64 significantly decreased the polymorphs and increased the lymphocytes. Pathological studies revealed no effect in the kidney and liver of treated animals after microscopic examination.


Both the adrenal glands and ovaries contribute to the circulating androgen pool in women. In ovarian theca cells, cholesterol is converted to androstenedione. The adrenal preferentially secretes weak androgens such as dehydroepiandrosterone (DHEA) or its sulfated depot form, DHEA-S (up to 90 of adrenal origin). These hormones, in addition to androstenedione, may serve as prohormones and may be converted to more potent androgens such as testosterone or dihydrotestosterone.

Premenarchal Vaginal Bleeding

Possible causes include ingestion of estrogen medication, a foreign body that irritates the vaginal lining, a cancer of the vagina or of the cervix (sarcoma botryoides), a tumor of the pituitary or adrenal gland, an ovarian tumor, sexual abuse, or idiopathic precocious puberty. The most common cause of premenarchal bleedingis_a foreign body.

Atrophic Vaginitis And Serosanguineous Discharge

(Griffiths, p 188.) Sertoli-Leydig cell tumors, which represent less than 1 of ovarian tumors, may produce symptoms of virilization. Histologically, they resemble fetal testes clinically, they must be distinguished from other functioning ovarian neoplasms as well as from tumors of the adrenal glands, since

Corticotropin Releasing Hormone and Urocortin

Corticotropin-releasing hormone (CRH) is synthesized in the PVN and LHA and is negatively regulated by levels of glucocorticoids. CRH is a key controller of the hypo-thalamic-pituitary axis (HPA), which regulates glucocorticoid secretion from the adrenal gland. Administration of CRH into the ventricular system potently reduces food intake, increases energy expenditure, and reduces body weight (195,196). As previously mentioned, when animals are overfed, they voluntarily reduced their food intake, and CRH mRNA in the PVN is also potently increased by involuntary overfeeding (188). The role of CRH in the regulation of food intake and body is complex owing to the presence of a binding protein within the CNS and evidence that inhibition of this binding protein results in decreased food intake (197).

Thiamine Diphosphate Activate The Aldehyde Is Transferred Beriberi

The answer is b. (Murray, pp 627-661. Scriver, pp3127-3164. Sack, pp 121-138. Wilson, pp 287-320.) Ferrous iron (Fe++) is the form absorbed in the intestine by ferritin, transported in plasma by transferrin, and stored in the liver in combination with ferritin or as hemosiderin. There is no known excretory pathway for iron, either in the ferric or ferrous form. For this reason, excessive iron uptake over a period of many years may cause hemochro-matosis (235200), the likely diagnosis for this man. This is a condition of extensive hemosiderin deposition in the liver, myocardium, pancreas, and adrenals. The resulting symptoms include liver cirrhosis, congestive heart failure, diabetes mellitus, and changes in skin pigmentation.

Blood Glucose and Related Blood Sugar Tests

An increase in blood glucose, hyperglycemia, usually indicates diabetes. Myocardial infarction, meningitis, or encephalitis, all of which produce acute stress in bodily processes, may also cause an elevated blood glucose level. Other conditions associated with hyperglycemia include an increased secretion of glucocorticoids from the adrenal glands as seen in Cushing's disease, pituitary and pancreatic adenomas, pancreatitis, hyperthyroidism, and chronic illness or inactivity.

Neuroendocrine modulation of immune responses

The interplay between the neuroendocrine and immune systems is bi-directional, as exemplified by the control of Cortisol release from the adrenal glands during stress. Cortisol has well-known anti-inflammatory properties and it also suppresses the immune system. The signal for the release of cortisol originates in the brain. Electrical signals generated in the brain, and also IL-1 and IL-6 synthesized in brain cells, stimulate the hypothalamus to produce corticotrophin-releasing hormone (CRH), which induces the anterior lobe of the pituitary gland to release adrenocorticotrophic hormone (ACTH). CRH can also induce lymphocytes to produce their own ACTH. The ACTH is released into the bloodstream and, on reaching the target organ (adrenal glands), stimulates the adrenal cells to secrete cortisol. At excessive concentrations, ACTH inhibits the release of CRH and ACTH by negative feedback to the hypothalamus and anterior pituitary gland.

Testicular Diffuse Large B Cell Lymphoma

Staining Testis

Testicular DLBCL typically presents with unilateral painless scrotal swelling in men whose median age is 60 to 70 years 6-9,12 . Both testes are involved at presentation in up to 15 of patients 6-8 , and 5 to 15 present with systemic ( B ) symptoms 6-9,13 . Approximately 50 of patients present with stage I disease (testes only), 20 with stage II disease (regional lymph node involvement), 5 with stage III disease, and 25 with stage IV disease (disseminated) 6-8,12 . Characteristic sites of distant organ involvement include the central nervous system (CNS) (especially), Waldeyer's ring, skin, bone and bone marrow, kidneys, adrenal glands, and lungs 4,6-8 . Compared to nodal DLBCL, testicular lymphoma is associated with presentation at an earlier stage and a greater propensity for spread to other extranodal sites. odal sites, including the CNS, contralateral testis, bone and bone marrow, skin, lung, and adrenal glands 4,6-8 . Although most relapses occur in the first 2 years after...

Immunocompromised patients

2 percent in northern Sweden (Forsgren et al., 1991 Evengard et al., 2001), and higher further south - up to 60 percent in Poland (Paul et al., 2000) - as well as being strongly age-dependent. Clinical signs of infection are similar to those in AIDS patients, and involve the brain, heart, and lungs. The organisms may also be present in eyes, liver, pancreas, adrenal glands, and kidneys. The initial presentation is often fever. Toxoplasma infection has also been described after heart, kidney, and liver transplantations (Aubert et al., 1996 Giordano et al., 2002 Renoult et al., 2004 Wulf et al., 2005). In most cases, infection manifests within 3 months following transplantation.

Afferent carry to Efferent carry away from

The renal tubule reabsorbs the fluid or filtrate passing through the tubular system, of the nephron. As fluid or filtrate passes through the renal tubule, the majority of the water, glucose, and other valuable substances are removed from the fluid, reabsorbed in the tubule, and returned to the cardiovascular system. Essential electrolytes such as sodium, chloride, and bicarbonate are reabsorbed in the tubules. The hormone aldosterone controls the reabsorption of sodium salts. Aldosterone is a hormone produced in the adrenal gland. Water and nonelectrolytes such as glucose, amino acids, and nutrients are also absorbed by renal tubes.

Extrahepatic Stellate Cells

Previous studies using fluorescence microscopy, transmission electron microscopy, and electron microscopic autoradiography showed that cells that stored vitamin A distributed in extrahepatic organs, namely, lung, digestive tract, spleen, adrenal gland, testis, uterus, lymph node, thymus, bone marrow, adventitia of the aorta, lamina propria of the trachea, oral mucosa, and tonsil (Matano et al., 1999 Nagy et al., 1997 Wake, 1980). Morphology of these cells was similar to that of fibroblasts. These cells emanate autofluorescence of vitamin A and contain lipid droplets in the cytoplasm. These cells and HSCs form the SC system that regulates homeostasis of vitamin A in the whole body. Extrahepatic SCs also can synthesize and secrete ECM components.

Von Hippel Lindau Disease

Von Hippel-Lindau (VHL) disease is a hereditary syndrome characterized by the development of multiple tumors, both benign and malignant, affecting several different organ systems 3 , including the eyes, spine, inner ear, pancreas, adrenal gland, and kidneys. Retinal angiomas, cerebellar and spinal hemangio-blastomas, and renal cell carcinomas are the hallmark lesions of this disease. Renal cysts, pancreatic cysts, pancreatic carcinomas, pheochromocytomas, epididymal or broad ligament cyst adenomas, and endolymphatic sac tumors may also occur in patients who suffer from this disease. Von Hippel-Lindau disease is estimated to affect approximately 1 in 36,000 individuals and is inherited in an autosomal-dominant fashion, with estimated penetrance of 80 to 90 by the age of 65 12,13 . Renal cell carcinoma eventually develops in approximately 28 to 45 of those individuals affected with VHL disease 3 . The tumors associated with

Reproductive Hormones

In females, estrogens are secreted by the developing ovarian follicle and by the corpus luteum (see Lesson 6, para 6-11b). During pregnancy, the placenta secretes estrogens. Estrogens are responsible for the development of the uterus, vagina, fallopian tubes, and breasts. Estrogen also produces such physiological effects as accelerating growth at puberty (causes epiphyses of long bones to close), increasing clotting factors in circulation, and decreasing bone reabsorption. Estrogen produces female secondary sex characteristics (like distribution of fat, development of pubic hair, high-pitch voice, and increased skin pigmentation). In males, there is limited estrogen secretion by the adrenal glands. (3) Anabolism increases the synthesis and decreases the breakdown of protein. Androgens also act to produce secondary sex characteristics associated with the male (like development of pubic hair and facial hair, development of a deeper pitched voice, and development of...

Adverse Effects Associated With Glucocorticoid Therapy

As you will recall, Cushing's disease results from hypersecretion of the adrenal glands. With iatrogenic Cushing's syndrome, the excessive amounts of glucocorticoids present in the body can be attributed to the medications the patient is taking. As you might expect, the same signs will be seen in both types of patients, moon face, buffalo hump, edema, hypertension, etc. e. Moon Face and Buffalo Hump. These conditions, which are also found in persons who suffer from hypersecretion of the adrenal glands, are also found in some people who are administered glucocorticoids. See paragraph 9-6b for a review of this topic,

Abnormalities Of Adrenal Functioning

In most individuals, the adrenal glands function as they should. That is, they produce the hormones needed in the body in the required amounts. However, for one reason or another, some persons find their adrenal glands not functioning as they should. Two such conditions are presented below a. Addison's Disease. Addison's disease results when the adrenal glands secrete too little of its hormones into the individual's system. Addison's disease is characterized by fatigue, muscle weakness, weight loss, low blood pressure, and gastrointestinal upset. b. Cushing's Disease. Cushing's disease results when the adrenal glands secrete too great a quantity of its hormones into the patient's system. Cushing's disease is characterized by atypical disposition of fat in the face (referred to as moon face), in the shoulder areas (referred to as buffalo hump), edema, hypertension, acne, and diabetes mellitus.

Hormonal changes at menopause

Estrogen levels in postmenopausal women are one-tenth of those in premenopausal women. Postmenopausal estrogens are produced by the adrenal glands and fat cells rather than the ovary, the primary source of premenopausal Another hormone that declines around the time of menopause is testosterone, produced in men as well as in women. In women, the ovaries and the adrenal glands are the major producers of testosterone. The adrenal glands produce dihydroepiandrosterone (DHEA), which is converted to testosterone in peripheral tissues. Testosterone affects the brain, bone, muscle, skin, blood vessels, and vagina and contributes to bone density, strength, energy, hair growth, and libido in women. Levels peak when women are in their twenties and decrease to about half that level when they are in their forties. Ovaries continue producing some testosterone throughout the lifespan.

Null Mutations in the POMC Gene

Knockout mice with a null mutation in the POMC gene and total absence of POMC peptides exhibit a phenocopy of the human disorder with marked obesity, adrenal glucocorticoid insufficiency, and altered coat pigmentation (83). Adrenal-gland development also appears to be abnormal and there is a non-Mendelian distribution of homozygote knockout mice, indicating pre- or perinatal lethality with incomplete penetrance.

Alphahydroxylase Deficiency

Lack of 21-hydroxylase causes a decrease in Cortisol with a consequent increase in ACTH, which in turn produces hyperplasia of the adrenals resulting in an increase in androgen production that gives rise to signs of female pseudohermaphroditism (as in this case) or enlarged genitalia in the male. May occur with or without salt wasting. p.326

Pathogenicity Of Corynebacteria

The virulent bacilli enter by way of the mouth or nose, invade the mucous membranes of the upper respiratory tract, multiply rapidly, and begin to produce a powerful exotoxin. The toxin is absorbed by the mucous membrane, resulting in acute inflammatory response and destruction of the epithelium. The exudation of fibrin, red blood cells, and white blood cells into the affected area results in the formation of a gray, clotted film, or pseudomembrane often covering the tonsils, pharynx, or larynx. As the disease progresses, the toxin is extended to more distant tissues causing necrosis, functional impairment, and sometimes gross hemorrhage of the heart, liver, kidneys, and adrenals. Neurotoxic manifestations are also evidenced by paralysis of the

The Catecholamine System Adrenal Medulla

The adrenal medulla, the inner part of the adrenal gland, is not essential to life, but helps a person in coping with physical and emotional stress. It consists of masses of neurons that are part of the sympathetic branch of the autonomic nervous system. Instead of releasing their neurotransmitters at a synapse, these neurons release them into the blood. Thus, although part of the nervous system, the adrenal medulla functions as an endocrine gland. It secretes epinephrine (also called adrenaline) and norepinephrine (also called noradrenaline). Both are derived from the amino acid tyrosine and are collectively called catecholamines, a group that includes other related substances with similar properties. The former hormone increases the heart rate and force of heart contractions, blood is shunted from the skin and viscera to the skeletal muscles, coronary arteries, liver, and brain, causes relaxation of smooth muscles, and helps with conversion of glycogen to glucose in the liver. Other...

Active transporters

Most of the relevant drug transporters have now been identified, and increasing evidence supports an important role of a few key transporters in the hepatic uptake of most drugs, rather than a large number of transporters with narrow substrate specificities. Transporters with the greatest potential for drug uptake are OATP-B, C and 8 and for efflux are P-gp and MRP2 (cMOAT) 65 . In particular, P-gp is perhaps the best known and studied. Although first studied by virtue of being expressed at high levels in some cancers, it is now known that normal tissues also express P-gp. For example, the canalicular domain of hepatocytes, kidney (proximal tubule), small intestine (brush border), colon, adrenal glands, and the capillary endothelium of the brain and testes all express

Other Organs

Two compartment models were sufficient to fit the data for adrenals, kidneys, lungs, small intestine, and testes in rats with low, marginal, and high liver vitamin A stores (Cifelli et al., 2005 Green et al., 1985, 1992 Lewis et al., 1990). As in the case of liver, retinol kinetics were adequately described by one compartment that rapidly exchanged vitamin A with plasma and a second, more slowly turning-over compartment that included tissue stores of the vitamin. In contrast, only one slowly turning-over compartment was required to fit tracer data from eyes of rats in the three groups (Green et al., 1992). Not surprisingly, kinetic parameters differed among organs within each dietary group. For example, in the rats that had the highest level of liver vitamin A stores, the fractional turnover of vitamin A in the eyes was lower than in the other organs examined (i.e., the transit time for vitamin A was longer in the eyes than in other organs), and the small intestine showed a higher...


When evaluating and comparing the results of the different studies, however, one has to keep in mind that size-definitions concerning significant pathology related to aortic aneurysms, adrenal gland, adenopathy, etc., differ from one study to another, thus influencing results.

Steroid hormones

Steroid hormones include the male sex hormones (collectively called androgens), the female sex hormones (oestrogens and progestins) and the hormones secreted by the cortex of the adrenal glands (the cor-ticosteroids). The hormones circulate in the blood both free and in combination with carrier proteins. The free steroids diffuse in and out of cells but are retained only in target cells through binding to specific receptor proteins, which are constitutively present. It was initially thought that, in the absence of hormone, the receptors were located in the cytoplasm and, after binding hormone, were rapidly translocated into the nucleus. It is now known that the unoccupied receptors are actively transported from the cytoplasm to the nucleus, but then diffuse back into the cytoplasm. This constant movement between nucleus and cytoplasm is known as nucleocytoplasmic shuttling.


Neuroblastoma is a malignancy of neural crest cells. These cells in the course of their normal development give rise to the paraspinal sympathetic ganglia (chromaffin) and the adrenal medulla. Tumors may arise anywhere neural crest cells are present (adrenal glands, sympathetic ganglia). They appear as rosettes with a central fibrillar material (dendrites) and mature ganglion cells.

Dilated Renal Pelvis

Renal Pelvis Dilation

The left adrenal gland lies anteromedial (not cranial) to the upper renal pole. The right adrenal gland extends posteriorly to the inferior vena cava. In adults, neither of the adrenal glands is visible, or only barely visible, in the perirenal fat. Hormone-producing adrenal tumors, such as an adenoma in Conn syndrome or hyperplasia in Cushing syndrome, are generally too small to be detectable sonographically. Only clinically manifest pheochromocytomas are often already several centimeters in size and can be sonographically detected in 90 of cases. Sonography plays a more important role in the detection of adrenal metastases (54) (Fig. 43.3). Metastases are usually seen as hypoechoic lesions between the upper renal pole and spleen (37) or inferior hepatic surface, respectively, and must be differentiated from atypical renal cysts (Fig. 43.3). The hematogenous spread of metastases is attributed to the exquisite vascularity of the adrenal glands and can be found with bronchogenic...

StAr Knockout Mice

Histology of the adrenal gland and gonads from newborn wild-type (WT) and StAR knockout (KO) mice. Steroidogenic organs were isolated from WT and StAR KO mice 1-6 d after birth, and sections were stained with oil red O and hematoxylin. (Top panels) Adrenal sections. (Middle panels) Testis sections. (Bottom panels) Ovary sections. The arrows point to areas of lipid deposits in the adrenal cortex and testis. Fig. 2. Histology of the adrenal gland and gonads from newborn wild-type (WT) and StAR knockout (KO) mice. Steroidogenic organs were isolated from WT and StAR KO mice 1-6 d after birth, and sections were stained with oil red O and hematoxylin. (Top panels) Adrenal sections. (Middle panels) Testis sections. (Bottom panels) Ovary sections. The arrows point to areas of lipid deposits in the adrenal cortex and testis.


The answer is c. (Berg, pp 681-682.) The association of erythrocy-tosis with cerebellar signs, microscopic hematuria, and hepatospleno-megaly suggests von Hippel-Lindau syndrome. This hereditary disorder is characterized by polycystic liver disease, polycystic kidney disease, retinal angiomas (telangiectasias), and cerebellar tumors. This is an autosomal dominant inherited disorder with variable penetrance. Men are more commonly affected than women. Although neoplastic cysts may develop in the cerebellum in persons with von Hippel-Lindau syndrome, these usually do not become sufficiently large to cause an obstructive hydrocephalus. Other abnormalities that occur with this syndrome include adenomas in many organs. Hemangiomas may be evident in the bones, adrenals, and ovaries. Hemangioblastomas may develop in the spinal cord or brainstem as well as in the cerebellum. This syndrome is not associated with acoustic schwannomas that could cause bilateral hearing loss and is not...

Left Lateral Flank

Left Lateral Decubitus Position

Right kidney, right adrenal gland, right renal hilum, liver (inferior portion), ascending colon, diaphragm, lung right costophrenic angle. Left kidney, left adrenal gland, left renal hilum, spleen (inferior portion), descending colon, diaphragm, lung left costophrenic angle. Spleen (for measurements), left hepatic flexure, pancreatic tail and splenic hilum, diaphragm, left adrenal gland, lung left costophrenic angle. Jejunum, aorta, vertebral column, transverse and descending colon, upper portion of the left kidney, left adrenal gland. abdomen, upper, 17, 21 abdomen, fetus, 65 abscess, hepatic, 30 accessory spleen, 48 achondroplasia, fetus, 72 acoustic shadowing, 6 acoustic window, 12 adrenal glands, 37-50 alpha-fetoprotein, 68 amniotic fluid, 71 amniotic membrane, 69 aneurysms, aortic, 13, 15, 19, 38 aorta, 12 aneurysm, 13, 19, 38 ectasia, 13 appendix, 53 arch artifacts, 10 artifacts, 9-10 ascites, 6, 24, 31, 36, 53, 69 atrial septal defect, 70 axial overview, 17-22

Dietary RA

The tracer response curves for the liver (Fig. 6), kidneys, small intestine, and lungs of RA-treated rats were visually different from the unsupplemen-ted rats as early as 2 h after administration of label. These differences were reflected in the model-predicted kinetic parameters. Specifically, the tissue residence times for vitamin A in the liver, kidneys, small intestine, and lungs were 14, 3.5, 5, and 75 times greater, respectively, in the RA-treated rats as compared to the unsupplemented ones. Similarly, the total traced mass of vitamin A in liver, kidneys, small intestine, and lungs was 11, 3, 5, and 31 times greater, respectively, in the RA-treated rats. The differences in the observed and model-predicted fractions of injected dose were a result of increased fractional input and decreased fractional output of vitamin A in the liver, kidneys, small intestine, and lungs of the RA-treated rats. For the other organs studied (eyes, testes, adrenals, and remaining carcass), there...


There are five mammalian melanocortin receptor subtypes involved in diverse physiological processes such as feeding behavior, energy balance, pigmentation, and stress response (235,236). The melanocortin-3 and -4 receptors (MC3R, MC4R) are expressed in the brain and implicated in body weight and feeding behavior regulation. The MC1R is expressed in the skin and implicated in skin and hair pigmentation. The MC2R is expressed in the adrenal gland and implicated in the stress response, part of the hypotha-lamic-pituitary adrenal (HPA) axis. Finally, the MC5R is ubiquitously expressed in the periphery and implicated in sebaceous gland physiology.


CT-Abdomen intra-abdominal mass arising from and obliterating left adrenal gland. Nuc (bone scan) metastatic lytic lesion in left orbital region of skull. Solid, round soft tumor mass obliterating left adrenal gland gray on cut surface showing extensive hemorrhage and necrosis with cyst formation.


In addition to active transport in the absorptive (mucosal to serosal) direction, it is now evident that active transporters exist that can limit absorption by causing the efflux of drugs in the reverse (serosal to mucosal) direction. One such transporter, the multidrug resistance gene product P-glycoprotein (P-gp), was initially discovered because it is expressed at high levels in some cancers cells and causes the net efflux of certain chemotherapeutic agents out of the cells, rendering them ineffective. However, it is now known that P-gp exists in many normal tissues, including the canalicular domain of hepatocytes, kidney (proximal tubule), small intestine, colon, adrenal glands, and the capillary endothelium of the brain and testes 65 . It is the expression of P-gp in the intestinal brush-border membrane of the small intestine that leads to net secretion of some drugs in the serosal-to-mucosal direction, serving as a secretory detoxifying mechanism and as a part of the absorption...

Nuclear Receptors

SF-1 (or Ad4BP) is an orphan nuclear receptor that was originally identified as a key regulator of steroidogenic enzyme genes in the adrenal cortex (111,112) (see Chapter 8). However, targeted ablation of this factor revealed developmental defects that were not restricted to the adrenal gland. In addition to the loss of adrenal glands, mice were born with gonadal agenesis (113). With the loss of gonadal steroid feedback, it was anticipated that gonadotropin gene expression would be elevated in the pituitaries of these mice. However, Parker and colleagues observed a significant diminution of the a, LHp, and FSHp mRNAs (64). Pituitary expression of the GnRH receptor gene was also significantly reduced (64). This suggested that GnRH signaling may be affected in these mice. While GnRH neurons were normal in number and position, the ventromedial hypothalamus, a region believed to control GnRH release, was not formed correctly (65). To directly prove that the loss of...


Testosterone, a male hormone, is responsible for sperm production and development of male secondary sex characteristics. Small amounts of testosterone are secreted by the ovaries and adrenal glands in women. Testosterone measurements assist in the assessment of various testicular conditions, pituitary function, and ovarian tumors or virilism in women.

Neuroimaging Studies

MRI studies have also provided substantial evidence for state-dependent adrenal gland enlargement (40-70 ) occurring during an episode of major depression 164 . Such an enlargement should not mislead the physician into diagnosing Cushing's syndrome, in which the enlargement is of greater magnitude and there are other associated laboratory and clinical features which differentiate it from depression.

And Function

In addition to Wt1 and M33, a strong candidate for a role in early gonadogenesis is the Ftz-F1 gene, which encodes the orphan nuclear-receptor steroidogenic factor 1 (SF1). In the fetus, SF1 has multiple roles in early gonadal, adrenal, and brain development, and throughout life is involved in the regulation of steroidogenesis in multiple tissues (see 43 and Chapter 8 for review). Mice homozygous for a null mutation in Sf1 lack adrenals, show gonadal degeneration after 11.5 dpc, have impaired gonadotrophic function, and altered structural characteristics of the ventromedial hypothalamus (44-47). Taken together, these studies demonstrate an essential role for Sf1 at multiple levels of the hypothalamic-pituitary-gonadal axis.

Abdominal Cavity

Remove the kidneys together with the adrenals (small glands in the superior pole of the kidneys, which are opaque and pale in females and rose-colored in males), cut the right kidney in two pieces, after very careful examination, and transfer one part together with the adrenal to the formalin as well as the intact left kidney.