fa2 adrenal pancreas

7/26/2019 Fa2 Adrenal Pancreas

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KELENJAR ADRENAL

dr Aris Prasetyo,M Kes


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Anatomi

Kuning

Berbentuk pyramid

Kelenjar suprarenal ,terletak di sisi atas ginjal Banyak vascularisasi

Berat + 7. g

Kelenjar adrenal dibagi ! bagian"# cortex adrenal di permukaan# medulla adrenal di lapisan dalam


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Cortex Adrenal Kekuningan $ simpanan lipids, c%olesterol dan

asam lemak.

Memproduksi %ormones steroid, oki disebut

adrenocortical steroid, atau diseder%anakancorticosteroid

Korticosteroid vital

&ormon steroid, menimbulkan e''ek denganmemili% gen dengan ditranskrip ke nukleus seltarget.


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3 Zones,dari corte( adrenal "

)*zona glomerulosa, diluar

)!zona fasciculata,di tengah

)zona reticularis, di dalam


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Region/Zone

Hormone(s !arget Hormonal E""ects Regulator# Control

Cortex

-ona

glomerulosa

Mineralocorticoid

s )M, primarilyaldosterone

Kidney /ncrease renal reabsorption

o' 0a+

and 1ater )especiallyin t%e presence o' A2& andaccelerate urinary loss o' K+

3timulated by

angiotensin //4in%ibited by A0P

-ona'asciculata

5lucocorticoids)5" cortisol)%ydrocortisone,

corticosterone,cortisone

Mostcells

6elease o' amino acids 'romskeletal muscles, and lipids'rom adipose tissues4

promote liver 'ormation4promote perip%eral glycogenutiliation o' lipids4 anti$in'lammatory e''ects

3timulated by A8&'rom anteriorpituitary gland

-ona

reticularis

Androgens 9ncertain signi'icance under

normal conditions

3timulated by

A8&4 signi'icanceuncertain

$edulla :pinep%rine,norepinep%rine

Mostcells

/ncrease cardiac activity,blood pressure, glycogenbreakdo1n, blood glucoselevels4 release o' lipids byadipose tissue

3timulated duringsympat%eticactivation bysympat%eticpreganglionic 'ibers


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Zona %lomerulosa memproduksi mineralocorticoid)Ms,

%ormon steroid

mempengaru%i komposisi electrolyte cairan tubu%.

Aldosteronadala% mineralocorticoid terpenting

+* persen volume cortical

glomerulusadala% bola$bola kecil

Bentuk kecil, padat, bergerombol


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Aldosterone $erangsang pertam&a'an ion sodium dan

eliminasi ion potassium #ang mengatur

komposisi cairan ekskresi

)ni men#e&a&kan retensi ion sodium di

gin*al+ kelen*ar keringat+kelen*ar sali,a dan

pancreas

mencega' ke'ilangan Na- di urine+

keringat+ sali,a+ dan digesti,e


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Retensi Na- disertai ke'ilangan K-

.e&agai e"ek samping+ rea&sorpsi Na-meningkatkan rea&sorpsi osmotik di gin*al+

kelen*ar keringat+ kelen*ar sali,a dan

pancreas

Aldosterone meningkatkan sensiti"itas

receptor garam di taste &uds di lida'

Aki&atn#a peningkatan keinginan

mengkonsumsi asinasin


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%angguan Aldosteron '#poaldosteronism

5agal memproduksi aldosterone dalam

jumla% cukup.

Ke%ilangan sejumla% besar air dan 0a+

Menguba% konsentrasi elektrolit

transmembrane potentials, 5angguan jaringan neural dan otot


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H#peraldosteronisme

2itandai dengan &ipertensi dan &ipokalemi

Macam "

Primer " 3indroma onn

3ekunder#3tenosis arteri renalis

#3irosis#Paya% jantung

#3indrom ne'rotik


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Aldosteronisme Primer

;anita


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2iagnosa

&iperaldosteron dan kadar renin yang

renda% dalam plasma

8 3can


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8erapi

Adrenalektomi

Posterior

Prabeda% " spironolakton !


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Zona 0asciculata

)fasciculus,ikatan kecil

memproduksi %ormon steroid "

glucocorticoids)5s

:''ek " metabolisme glucose

+7? persen volume kortek

3el endocrinenya besar dan mengandungbanyak lipid, tampak berbusa


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Glucocorticoids

2irangsang A8& dari %ipo'ise anterior

Produk terpentingnya cortisol, disebut juga

hydrocortisone dengan jumla% yang lebi% kecil dalam bentukcorticosterone dan cortisone

3ekresi 5lucocorticoid di regulasi dengan negative

'eedback" pelepasan glucocorticoids mempunyaie'ek meng%ambat produksi corticotropin$releasing%ormone )6& di %ypot%alamus dan A8& di%ipo'ise anterior


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antiin"lammator# e""ect

meng%ambat akti'itas sel leukosit dankomponen sistem imun lain

3teroid cream biasa digunakan mengatasi

alergi injeksi glucocorticoid mengatasi reaksi

alergi yang lebi% berat


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%angguan 1roduksi

%lucocorticoid Addison2s disease

#produksi glucocorticoid inadeuate

#autoimmune response#kelema%an dan ke%ilangan berat badan

#tidak dapat menggunakan cadangan lipid secarae'ekti' untuk memproduksi A8P

#konsentrasi glucose dara% turun se%abis makan#symptom mirip %ypoaldosteronism


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2iagnosa

#8es lab#Kadar kalium plasma meningkat

#Kadar natrium dan klorida normal

#A8& serum meningkat 8erapi

#airan iv

#Kortikosteroid iv po


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Cus'ing2s disease

#@verproduksi glucocorticoids

#2iagnosa banding " esi %ipo'isis menyebabkan&ypersekresi A8&

#Metabolism 5lucose ditekan


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5ejala

;anitaCC

5ejala kelebi%an sekresi kortisol"

#Atro'i otot, protein peri'er dipeca%

#@besitas, cadangan lipid dimobilisasi $ Dmoon$

'acedD appearance

#3triae#%iperpigmentasi


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2iagnosa

Kadar A8& plasma renda%

8 3can untuk menyingkirkan karena lesi

%ipo'isis


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Zona Reticularis

Reticulum =net1ork

7 E corte( adrenal

branc%ing net1ork

memproduksi androgens

selain di testis

juga memproduksi estrogens

e''ek pada se(ual c%aracteristics A8& merangsang ona reticularis tapi

minimal


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%angguan pada Zona Reticularis

8umor

androgen meningkat drastis

adrenogenital syndrome

pada 1anita$maskulin

#postur tubu%

#bulu>rambut

#distribusi tumpukan lemak

#berotot

pada laki$laki$ 'eminin

#gynecomastia )gynaikos,1oman + mastos,breast.


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$edulla Adrenal

ber1arna coklat kemera%an$ kaya pembulu%dara%

3elnya bulatF mirip ganglion sympat%eticyang diinnervasi ole% preganglionicsympat%etic 'ibers

akti'itas sekresi dikontrol ole% divisisympat%etic dari sara' otonom


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medulla adrenal mengandung dua kelompoksel sekretory"

#epinep%rine )adrenaline#norepinep%rine )noradrenaline.

3ekresinya dikemas dalam vesicles

e(ocytosis 6angsangan sympatis merangsang

peningkatan e(ocytosis dan pelepasan %ormonsecara dramatis


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$edulla Adrenal

1reganglionic "i&ersmasuk ke medulla adrenal

medulla adrenal adala% modi'ikasi ganglion

simpatis 2i dalam medulla, preganglionic 'ibers melakukan

synapse pada sel neuroendocrine,neurons k%ususyang melepas neurotransmitters epinephrine (E

dan norepinephrine (!Eke sirkulasi.


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$em&rane Receptors

Ada ! kelompok sympat%etic receptors"

#alpha receptors

#"eta receptors.


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Alpha Receptors

3timulasi alp'a receptorsmengakti'kan enym dimembran sel.

Ada ! tipe alp%a receptors"# alp%a$*

# alp%a$!


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Kelainan $edullaeAdrenal

4,erproduksi epinep'rine ole' medullaadrenal

1'eoc'romoc#toma

!umor #ang memproduksi catec'olamin 55

!'e most dangerous s#mptoms are rapid andirregular 'eart&eat and 'ig' &lood pressure6

4t'er s#mptoms include uneasiness+ s7eating+&lurred ,ision+ and 'eadac'es

.urgical remo,al o" t'e tumor is t'e moste""ecti,e treatment


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Pancreas


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pancreatic islets

islets of #angerhans.


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/nsulin

Peptide %ormone

released by beta cells 1%en glucose levels

rise above normal levels )7dl. /nsulin secretion is also stimulated by

elevated levels o' some amino acids,

including arginine and leucine. Binds to receptor proteins on t%e cellmembrane. .


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@ne o' t%e most important e''ects is t%e

en%ancement o' glucose absorption and utiliation /nsulin receptors are present in most cellmembranes4 suc% cells are called insulin-dependent.

ells in t%e brain and kidneys, cells in t%e liningo' t%e digestive tract, and red blood cells lackinsulin receptors.

8%ese cells are called insulin-independent,because t%ey can absorb and utilie glucose1it%out insulin stimulation.


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8%e e''ects o' insulin on its target cells

include" $cceleration of glucose uptake (all target cells.

$cceleration of glucose utilization (all target

cells and enhanced $%& production.

'timulation of glycogen formation (skeletalmuscles and lier cells.

'timulation of amino acid a"sorption and protein

synthesis.

'timulation of triglyceride formation in adipose

tissues.


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/nsulin is secreted 1%en glucose is

abundant, and t%is %ormone stimulates

glucose utiliation to support gro1t% and t%eestablis%ment o' carbo%ydrate )glycogen

and lipid )triglyceride reserves.

8%e accelerated use o' glucose soon bringscirculating glucose levels 1it%in normal

limits.


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2iabetes Mellitus

2iabetes mellitus )mellitum,%oney isc%aracteried by glucose concentrations t%at are%ig% enoug% to over1%elm t%e reabsorption

capabilities o' t%e kidneys.

5lucose appears in t%e urine )glycosuria, and urineproduction generally becomes e(cessive )polyuria.

@t%er metabolic products, suc% as 'atty acids andot%er lipids, are also present in abnormalconcentrations.


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aused by genetic abnormalities, and some o' t%e

genes responsible %ave been identi'ied

# inadeuate insulin production

# t%e synt%esis o' abnormal insulin molecules

# de'ective receptor

2iabetes mellitus may also appear as t%e result o'ot%er pat%ological conditions, injuries, immune

disorders, or %ormonal imbalances

8%ere are t1o major types o' diabetes mellitus"

# insulin)dependent (%ype * dia"etesand

# non)insulin)dependent (%ype ** dia"etes.


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)nsulinDependent Dia&etes

$ellitus 8ype / diabetes,

inadeuate insulin production by t%e beta cells o'

t%e pancreatic islets. 5lucose transport in most cells cannot occur in t%eabsence o' insulin.

;%en insulin concentrations decline, cells can no

longer absorb glucose4 tissues remain glucose$starved despite t%e presence o' adeuate or evene(cessive amounts o' glucose in t%e circulation.


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A'ter a meal ric% in glucose, blood glucoseconcentrations may become so elevated t%at t%ekidney cells cannot reclaim all t%e glucosemolecules t%at enter t%e urine.

8%e %ig% urinary concentration o' glucose limits

t%e ability o' t%e kidneys to conserve 1ater, so t%eindividual urinates 'reuently and may becomede%ydrated.

8%e c%ronic de%ydration leads to disturbances o'

neural 'unction )blurred vision, tinglingsensations, disorientation, 'atigue and muscle1eakness.


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under =< years o' age.

juvenile$onset diabetes.


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0on$insulin$dependent diabetes

mellitus )0/22M 8ype // diabetes, typically a''ects obese

individuals over =< year o' age.

8ype // diabetes is 'ar more common t%an8ype / diabetes

H< percent o' t%em involve obese

individuals.


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8%e primary e''ects o' glucagon "

'timulation of glycogen "reakdo+n in

skeletal muscle and lier cells.

'timulation of triglyceride "reakdo+n inadipose tissues.

'timulation of glucose production at the

lier.


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Structure/Cells

Hormone

PrimaryTargets Hormonal Effects Regulatory Control

Alphacells

Glucagon

Liver,adiposetissues

Mobilizes lipid reserves;promotes glucose synthesis

and glycogen breakdown inliver; elevates blood glucoseconcentrations

Stimulated by low blood glucoseconcentrations; inhibited bysomatostatin from delta cells

Betacells Insulin Most cells

acilitates uptake of glucoseby target cells; stimulates lipid

and glycogen formation andstorage

Stimulated by high blood glucoseconcentrations, parasympatheticstimulation, and high levels ofsome amino acids; inhibited by

somatostatin from delta cells andby sympathetic activation

Deltacells

Somatostatin!G"#I"$

%ther isletcells,digestiveepithelium

Inhibits insulin and glucagonsecretion; slows rates ofnutrient absorption andenzyme secretion alongdigestive tract

Stimulated by protein#rich meal;mechanism uncertain

F cells

&ancreaticpolypeptide

'igestiveorgans

Inhibits gallbladder contraction;regulates production ofpancreatic enzymes;influences rate of nutrientabsorption by digestive tract

Stimulated by protein#rich mealand by parasympatheticstimulation

fa2 adrenal pancreas

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