内分泌生殖系统教学课件：06 肾上腺髓质.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,The Adrenal Glands Part,The Adrenal medulla,Part 1 Introduction,Adrenal Glands,Blood supply,Nerve supply,AD,Embryology of the adrenal gland,Part 2 Adrenal medulla,At the interface between the neural and endocrine system,Case:Mrs.Smith,a 45-year-old woman,Worried for panic attacks,Sweating,Palpitation,Sudden episodes of rapid heart beating,Frightened,Examination,Pale,P:100/min,BP:,155/105 to 260-165 mmHg,Investigation,Serum sodium:141mmol/L(),Serum potassium:3.2mmol/L(),Plasma noradrenaline:,12nmol/L(),Plasma adrenaline,:6.7nmol/L(),Adrenal medulla,Composed of polygonal cells arranged in cords or cluster,Numerous wide diameter capillaries,Sympathetic ganglion,Adrenal medulla,chromate salt stain,Brownish cytoplasm granules-when fixed by chromate salt containing fixative,Also called chromaffin cell,Hormones of adrenal medulla,Catecholamines,Adrenaline,Noradrenaline,Dopamine,Peptides,Opiate peptides,Adrenomedullin,Arginine vasopressin,Vasoactive intestinal peptide,Catecholamine(CA),Synthesis of catecholamine,Synthesis of catecholamine,PNMT,Regulated by glucocorticoids,.,Secretion of catecholamine,Regulation of catecholamine secretion,The activity of the adrenal medulla is regulated by the activity of the sympathetic nerve.,Transport and metabolism of adrenal medullary hormones,(1)No specific binding proteins,(2)Onset rapid and short-lived,(3)Metabolized by COMT and MAO,(4)End product:VMA,Actions of adrenal medullary hormones,Fight and flight neuroendocrine response,Emergency reaction hypothesis:,W.B.Cannon,1928,Through activating adrenoceptors,Case:What is the cause?,Over-secretion of the CA,Palpitation,Sudden episodes of rapid heart beating,Frightened,Pale,P:100/min,BP:,155/105 to 260-165 mmHg,Plasma noradrenaline:12nmol/L(),Plasma adrenaline:6.7nmol/L(),Part 3,Disorders of the adrenal medulla,Phaeochromocytoma:a tumor causes,adrenal medullary hormones over-secretion,Phaeochromocytoma,Symptoms:,with emergency reaction frequently,Diagnosis,(1),CT,and MIBG:,localization,(2),Symptoms:,HBP,HG,high BMR,(3),VMA,AD and NA,in urineTreatment,(1)Operation,(2)Adrenoceptor antagonists,-adrenoreceptor blockers,-adrenoreceptor blockers,Case:treatment,(1)Drug treatment:,-blockers,-blockers,(2)To find the source:CT and MIBG scan,(3)Operation,Familial Phaeochromocytoma,Part 3 Pharmacological uses of adrenal medullary hormones,Clinical uses,of adrenaline,1.,Cardiac arrest,2.Allergic shock:,first choice,3.Bronchial asthma,4.P,rolongation of local anesthetic duration,5.Topical h,emorrhage,bronchial mucosa vessel dilation,HA,SRS,PGs,BK,Ag-Ab,Allergized cells,Bronchial SM contraction,dyspnea,Intrathoracic pressure,returned blood volume,SBP,Vessel dilation,DBP,mucosal edema,AD:first choice for allergic shock,AD,x,x,x,x,x,Clinical uses,of NA,Shock and hypotension,2.Upper digestive tract hemorrhage,Endocrine hypertension,Belongs to secondary hypertension:,Conns syndrome,Cushings syndrome,Phaeochromocytoma,