The adrenal medulla in cardiovascular medicine: an untold story
| Autor: | Danielle Esler, Garry L. Jennings, Murray D. Esler, Elisabeth Lambert, Marlies Alvarenga, Jane M. Thompson, Gavin W. Lambert, Markus P. Schlaich, Nina Eikelis, Ling Guo, David M. Kaye |
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| Rok vydání: | 2020 |
| Předmět: |
Sympathetic nervous system
medicine.medical_specialty Sympathetic Nervous System Epinephrine Physiology Stimulation 030204 cardiovascular system & hematology Norepinephrine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Internal Medicine medicine Humans Sympathoadrenal system 030212 general & internal medicine Neurotransmitter business.industry medicine.disease Thrombosis medicine.anatomical_structure Endocrinology chemistry Adrenal Medulla Heart failure Hypertension Cardiology and Cardiovascular Medicine business Adrenal medulla Hormone |
| Zdroj: | Journal of Hypertension. 39:819-829 |
| ISSN: | 1473-5598 0263-6352 |
| Popis: | Unlike noradrenaline, the sympathetic neurotransmitter which overflows to the circulation, adrenaline (ADR) is a secreted hormone, with a low plasma concentration, and plasma concentration for biological action a log order lower than that of noradrenaline. The venous drainage of the left adrenal medulla into the left renal vein does expose this vein to uniquely high plasma ADR concentrations and possible risk of thrombosis at high rates of ADR secretion. There is typically a different timeframe for adrenal medullary and sympathetic nervous system responses: ADR release is short term in contrast with sympathetic activation persisting for years in heart failure and hypertension. The historic view of Walter Cannon, subject to recent review, that the sympathoadrenal system is a unified biological system, was deconstructed further with demonstration of frequent mismatching of adrenal medullary and sympathetic nervous responses. Under gravity stimulation with standing, there is prompt sympathetic activation without ADR release. In many diseases, notably obesity, hypertension, heart failure and depressive illness, an activated sympathetic nervous system and silent adrenal medulla coexist. The therapeutic corollary of this is that ADR blockade is much less commonly needed clinically than pharmacological antagonism of the sympathetic nervous system. |
| Databáze: | OpenAIRE |
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