The adrenal glands are vital in the organism's response to environmental stress. The outer cortex releases steroid hormones: glucocorticoids, mineralocorticoids and sex hormones, which are crucial to metabolism, inflammatory reactions and fluid homeostasis. The medulla is different developmentally, functionally and structurally. It co-releases catecholamines (primarily adrenaline and to some extent noradrenaline) as well as peptides by the all-or-none process of exocytosis from chromaffin granules, to aid in blood pressure and blood flow regulation, with regulated increments during the activation of the sympathetic nervous system. The co-released peptides function to regulate catecholamine release, blood vessel contraction and innate immune responses. Pathology within the adrenal medulla and the autonomic nervous system is primarily because of neoplasms. The most common tumour, called phaeochromocytoma when located in the adrenal medulla, originates from chromaffin cells and excretes catecholamines, but may be referred to as secreting paragangliomas when found in extra-adrenal chromaffin cells. Neoplasms, such as neuroblastomas and ganglioneuromas, may also be of neuronal lineage. We will also briefly discuss the catecholamine deficiency state.
Keywordsadrenal; catecholamine; chromaffin; phaeochromocytoma
Anatomy and physiologyThe adrenal medulla is the location of the majority of the organism's chromaffin cells, derived embryologically from neuroectoderm; ganglion cells and sustentacular cells are also found in the medulla. Chromaffin cells, which store catecholamines in secretory vesicles also known as chromaffin granules, are found in clusters (or nests) and in trabeculae, whereas the ganglion cells are found singly or in clusters interspersed among the chromaffin cells or in association with nerve fibres. The sustentacular cells, or support cells, are located at the periphery of clusters of chromaffin cells.The precursor chromaffin cells differentiate at the centre of the adrenal gland in response to the glucocorticoid cortisol. A minority of these cells also migrate to form paraganglia, collections of chromaffin cells on both sides of the aorta, the largest of which is primarily found at the origin of the inferior mesenteric artery or at the bifurcation of the aorta and is referred to as the organ of Zuckerkandl.Correspondence: D. T. O'Connor, Departments of Medicine and Pharmacology, Center for Human Genetics and Genomics (CHGG), University of California at San Diego, Skaggs (SSPPS) room 4256, 9500 Gilman Drive, La Jolla, CA 92093-0838, USA. E-mail: doconnor@ucsd.edu.
Conflict of interestThere are no conflicts of interest for any of the authors for this paper.
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NIH-PA Author ManuscriptThe catecholamines are discharged from the chromaffin granules and sympathetic axons by the process of exocytosis, wherein all soluble components of the granule, including enzymes and chromogranins and bioactive peptides, are co-released into the extra...