- Title
- The adrenal medulla in cardiovascular medicine: an untold story
- Creator
- Esler, Murray; Jennings, Garry; Schlaich, Markus; Lambert, Gavin; Thompson, Jane; Lambert, Elisabeth; Guo, Ling; Alvarenga, Marlies; Esler, Danielle; Eikelis, Nina; Kaye, David
- Date
- 2021
- Type
- Text; Journal article
- Identifier
- http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/198230
- Identifier
- vital:19004
- Identifier
-
https://doi.org/10.1097/HJH.0000000000002748
- Identifier
- ISSN:0263-6352
- Abstract
- 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 responsesADR 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.
- Publisher
- Wolters Kluwer Health, Inc. All rights reserved
- Relation
- Journal of Hypertension Vol. 39, no. 5 (2021), p. 819-829
- Rights
- All metadata describing materials held in, or linked to, the repository is freely available under a CC0 licence
- Rights
- Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
- Subject
- Adrenal medulla; Cardiovascular system & hematology; Clinical medicine; Endocrinology; General & internal medicine; Heart failure; Hormone; Internal medicine; medical and health sciences; Neurotransmitter; Stimulation; Sympathetic nervous system; Sympathoadrenal system; Thrombosis; 3201 Cardiovascular medicine and haematology; 3202 Clinical sciences
- Reviewed
- Hits: 356
- Visitors: 356
- Downloads: 0