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Harrison's Principles of Internal Medicine, 17e
| Part Fifteen: Endocrinology and Metabolism > Section 1: Endocrinology > |
Chapter 336. Disorders of the Adrenal Cortex
Sections: Biochemistry and Physiology, Laboratory Evaluation of Adrenocortical Function, Hyperfunction of the Adrenal Cortex, Hypofunction of the Adrenal Cortex, Hypoaldosteronism, Pharmacologic Clinical Uses of Adrenal Steroids, Further Readings.
Topics Discussed: adrenal gland disorders.
Excerpt:
"The adrenal cortex produces three major classes of steroids:
(1) glucocorticoids, (2) mineralocorticoids, and (3) adrenal androgens.
Consequently, normal adrenal function is important for modulating
intermediary metabolism and immune responses through glucocorticoids;
blood pressure, vascular volume, and electrolytes through mineralocorticoids;
and secondary sexual characteristics (in females) through androgens.
The adrenal axis plays an important role in the stress response
by rapidly increasing cortisol levels. Adrenal disorders include
hyperfunction (Cushing's syndrome) and hypofunction (adrenal
insufficiency), as well as a variety of genetic abnormalities of
steroidogenesis.The basic structure of steroids is built upon a five-ring nucleus (Fig. 336-1). The carbon atoms
are numbered in a sequence beginning with ring A. Adrenal steroids
contain either 19 or 21 carbon atoms. The C19 steroids
have methyl groups at C-18 and C-19. C19 steroids with
a ketone group at C-17 are termed 17-ketosteroids;
C19 steroids have predominantly androgenic activity. The
C21 steroids have a 2-carbon side chain (C-20 and C-21)
attached at position 17 and methyl groups at C-18..."
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