Aldosterone regulates electrolyte excretion and the intravascular volume through its effects on the distal tubules and cortical collecting tubes of the kidney. It binds to a miner-alocorticoid receptor in the cytosol and moves into the nucleus to increase transcription.8 The early effect is to increase the Na absorption through the Na channels. Via changes in electrical potential across the renal tubule, K and H secretion are increased. This leads to an expanded intravascular volume and suppresses renin secretion. Chronically increased aldosterone secretion is characterized by increased peripheral vascular resistance and persistent high blood pressure.
Cortisol exerts its effect by regulating gene transcription after binding to glucocorticoid receptors within the cell.9 Cortisol has a large number of metabolic effects on several tissues. However, many of the effects of glucocorticoids are based on studies of patients, animals, and cells with non-physiologically high or low levels of glucocorticoids.
Glucocorticoids are necessary for maintaining hepatic glycogen stores. They stimulate protein catabolism and lipolysis and cause hyperinsulinemia.1 Cortisol is required for maintenance of normal blood pressure. The effect on immunologic function of glucocorticoids in physiologic levels is not clear, but glucocorticoid excess suppresses both immunologic and anti-inflammatory responses. Glucocorticoids have a weak mineralocorticoid effect and influence calcium homeostasis by decreasing intestinal calcium absorption and increasing urinary calcium excretion.1 In pharmacologic doses, Cortisol causes osteoporosis. The effects of Cortisol on the central nervous system manifest as changes in excitability, behavior, and mood.1
The physiologic effects of DHEA-S, DHEA, and androstene-dione are relatively weak, and they undergo conversion to testosterone in peripheral tissue. In females, androgens produced by the adrenal glands sustain normal pubic and axillary hair growth, and after menopause the adrenal glands are a major source of estradiol. However, in males, the high amount of androgens produced by the testis exceeds that produced by the adrenal glands.1
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