Altered Adrenal Function and the Autonomic Nervous System

Publisher Summary This chapter focuses on altered adrenal function, the autonomic nervous system, and the influence of the autonomic nervous system on adrenocortical function. The adrenal gland consists of the outer cortex and the inner medulla. The adrenal cortex consists of the outer zona glomerulosa that secretes aldosterone which plays a major role in regulation of blood pressure, volume and potassium balance. Primary adrenal insufficiency results from destruction of the adrenal cortex. Autoimmune adrenalitis remains the predominant cause for primary adrenocortical dysfunction in the western world. The adrenal cortex and medulla appear to be interlaced with multiple areas of contact that are not separated by connective tissue or interstitial membranes. The most common symptoms include weakness, malaise, fatigue, weight loss, anorexia, and nausea. The distinctive clinical features of chronic primary adrenal insufficiency include hyperpigmentation and salt craving. The autonomic nervous system also may play a role in mediating the increased cardiovascular risk associated with aldosterone. It is indicated that aldosterone can centrally increase the sympathetic activity in the brain.