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Intraadrenal Interactions in the Regulation of Adrenocortical Steroidogenesis

Department of Internal Medicine III (M.E.-B.), University of Leipzig, 04103 Leipzig, Germany; Department of Biochemistry (J.P.H., G.P.V.), Queen Mary and Westfield College, London E14NS, England; National Institute of Child Health and Human Development (S.R.B.), National Institutes of Health, Bethesda, Maryland 20892; and Diabetes Research Institute at the Heinrich Heine University (W.A.S.), 40225 Düsseldorf, Germany

I. Introduction: The Adrenal Functional Unit

II. Interaction Between Adrenal Medulla and Adrenal Cortex

A. Relationship between medullary and cortical cells

B. Paracrine control of adrenocortical function by the adrenal medulla

C. Gap junctions in the adrenal cortex

D. Summary

III. Innervation of the Adrenal Cortex

A. Evidence for a nerve supply to the adrenal cortex

B. The source of adrenocortical innervation

C. Regulation of adrenocortical innervation

D. Role of the splanchnic nerve in regulating adrenocortical neural function

E. Influence of adrenal innervation on adrenocortical function

F. Effects of neurotransmitter substances on adrenocortical function

G. Summary

IV. The Vascular System of the Adrenal Gland

A. Regulation of blood flow

B. Relationship between blood flow and steroid secretion

C. Effects of vascular endothelial cell products on steroid secretion

D. Summary

V. The Intraadrenal CRH/ACTH System

A. Extrapituitary effect of CRH

B. Intraadrenal ACTH

C. Intraadrenal CRH and CRH receptors

D. Feedback mechanisms

E. Summary

VI. Immune Cells and Cytokines in the Adrenal Gland

A. Source of cytokines within the adrenal

B. Cytokines that influence the adrenal cortex

C. Summary

VII. Peptide Growth Factors and the Adrenal Cortex

A. FGFs

B. IGFs

C. TGFß

D. Summary

VIII. The Intraadrenal Renin-Angiotensin System (RAS)

A. The role of the RAS in adrenocortical function

B. Renin

C. Angiotensinogen

D. Angiotensin-converting enzyme and the production of angiotensin II

E. What is the functional significance of the intraadrenal RAS?

F. How can the angiotensin II produced by the tissue RAS be distinguished from the systemic system?

G. Summary

IX. Clinical Implications

A. Cortisol

B. Aldosterone

C. Adrenal androgens

D. Summary

X. Conclusions

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