By Dimitrios A. Linos, Jon A. van Heerden
- Over 2 hundred beautiful illustrations, starting from intraoperative photos, line drawings, diagnostic pictures, pathology slides, tables and graphs can be found to make every one case mentioned understandable and straightforward to follow.
- conventional and novel healing options are introducedand the newest advancements in minimal-access operative concepts are mentioned and reviewed.
- makes a speciality of a teamwork orientated procedure that identifies the required communications among the various clinical disciplines whilst facing adrenal problems.
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Extra resources for Adrenal Glands Diagnostic Aspects and Surgical Therapy
3 Adrenal Cortex: Glucocorticoids At the level of the adrenal cortex, glucocorticoids synthesized in the zona fasciculata are the final effectors of the HPA axis and direct the stress response toward the goal of maintaining homeostasis. Cortisol, the main endogenous glucocorticoid in humans,is secreted by the adrenals into the circulation to reach the peripheral target tissues, where it exerts its effects via specific cytoplasmic receptors. In the unbound/inactive state, the glucocorticoid receptors are found as hetero-oligomers with heat shock protein (hsp) 90 and other proteins,which include hsp 70 and immunophillin [100, 107].
All of these vessels then converge towards the smallest of the collecting veins in the medulla that empty into the central adrenal vein. Thus, the central vein collects blood from both the cortex and the medulla (Fig. 1). There they divide into arterioles and capillaries. Thus,the medulla receives two types of blood. A small fraction of its blood is supplied directly by the capsular-subcapsular plexus, via the arteriae medullae, but most, at least under conditions of stimulation, must come from the cortex .
A decade later, in vitro studies supported the existence of such a hypothalamic corticotropin-releasing factor by demonstrating that hypothalamic extracts could stimulate pituitary corticotroph cells to secrete ACTH. In 1981, Vale and his colleagues announced the sequence of a 41-aminoacid peptide from ovine hypothalami, designated corticotropin-releasing hormone (CRH), which showed greater ACTH-releasing potency in vitro and in vivo than any other previously identified endogenous or synthetic peptide.
Adrenal Glands Diagnostic Aspects and Surgical Therapy by Dimitrios A. Linos, Jon A. van Heerden