s21 a Cortezasuprarreal

7/23/2019 s21 a Cortezasuprarreal

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Christian Prof. Rosa 21/22 -03-06

CORTEZA SUPRARRENAL – CORTCO!ES

Es "na #$an%"$a &"' (o&)$*+a *n $a ,"* s* fari(an (orti(oi%*s. a' 0 ti)os %*(orti(oi%*s t*ni*n%o *n ("*nta $os )r*("rsor*s r*s"$ta%o %* (atao$is&os

Los (orti(oi%*s s* ($asifi(an *n 3 #r")osGlucocorticoides S" f"n(in $o r*a$i4an sor* $a #$"(osa.

Mineralocorticoides S" *f*(to $o r*a$i4an sor* so%io ' )otasio.

Sexocorticoides 5 Ti*n*n $a &is&a f"n(in ,"* $a #$n%"$a " hor&onass*7"a$*s. Son hor&onas (on *f*(to s*7"a$ &as("$ino 'a s* sint*ti(*n *nho&r*s o &"+*r*s.

En $a (ort*4a s")rarr*na$ s* %istin#"*n tr*s (a)as Ca)a 8$o&*r"$ar E7t*rna. Sint*ti4a AL!OSTERONA.

Ca)a 9as(i("$ar :*%ia. Sint*ti4a CORTSOL.Ca)a R*ti("$ar nt*rna.Sint*ti4a SE;OCORTCO!ES.

La (a)a #$o&*r"$ar *s $a <ni(a ,"* sint*ti4a a$%ost*rona ,"* *s *$&in*ra$o(orti(oi%* &as i&)ortant*. En $a (a)a fas(i("$ar s* sint*ti4a *$ (ortiso$ ,"* *s*$ #$"(o(orti(oi%* &s i&)ortant*. = *n $a (a)a r*ti("$ar s* sint*ti4an $oss*7o(orti(oi%*s.

ESTRUCTURA >U?:CACi($o)*ntano )*rhi%rof*nantr*no.

P*rt*n*(* a $os *st*roi%*s ,"* son #rasas ' no son so$"$*s *n a#"a. Co&on<($*o %* s" &o$@("$a *s $a *str"(t"ra ant*rior&*nt* &*n(iona%a. Esta *str"(t"rata&i@n a)ar*(* (o&o n<($*o %*$ (o$*st*ro$ $a ita&ina ! ' otras.

A$#"nas %* $as hor&onas aBa%*n "n #r")o &*ti$o -C3 D *n *$ (arono 13 ' )or tanto $a &o$@("$a 'a ti*n* 1 Caronos ESTRANO. !* *st* *strano )ro(*%*n $os*str#*nos ,"* son $os &s )*,"*Bos o si&)$*s (on 1 Caronos.

ABa%i*n%o a$ *strano otro &*ti$o *n *$ Carono 10 t*n*&os "n (o&)"*sto %*1F Caronos AN!OSTRANO. !*$ an%ostrano )ro(*%*n $as hor&onas s*7"a$*s

&as("$inas (on 1F Caronos.

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Si s*#"i&os aBa%i*n%o &@ti$os 2 (on(r*ta&*nt* *n *$ Carono 1G t*n*&os "n(o&)"*sto %* 21 Caronos PRE8NANO. !*$ ,"* %*riHan *$ r*sto %* hor&onas*st*roi%*as

8$"(o(orti(oi%*s:in*ra$o(orti(oi%*sPro#*st*rona

Para ,"* *$ )r*#nano s* (onHi*rta *n &o$@("$a a(tiHa ha' ,"* aBa%ir$* #r")os hi%ro7i$o-OD &)r*s(in%i$*s #r")o (*tni(o *n )osi(in 3 %o$* *n$a(* *ntr* I ' ' #r")o(*tni(o *n )osi(in 20.

Pr*s(in%i$*s #r")os –O *n )osi(in 11 1G ' 21. No ti*n*n )or,"* t*n*r $os 3 –O )or *+*&)$o si $* fa$ta *$ 11%*so7i(orti(oi%*s

,"* son &in*r*$*(orti(oi%*s.

CORTSOLCORTCOSTERONA 8$"(o(ori(oi%*s &as i&)ortant*.

CORTSOLTi*n* to%o $o %i(ho ant*rior&*nt*. Es *$ #$"(o(orti(oi%* )or *7(*$*n(ia.

Es $a hor&ona &s i&)ortant* 'a ,"* s* "ti$i4a *n trata&i*nto %* (i*rtas *nf*r&*%a%*s.S* han h*(ho (orti(oi%*s sint@ti(os %*i%o a s" i&)ortan(ia *n $a &*%i(ina )ara

*sto (o#*n $a &o$@("$a ' $a &o%ifi(an aBa%i@n%o$* o ,"itn%o$* ra%i(a$*s.Si s* aBa%* *n $a )osi(in F 9$"or s* $$a&a F-alfa –9$"or(ortiso$.Si s* aBa%* "n %o$* *n$a(* *ntr* $os Caronos 1 ' 2 s* $$a&a

Pr*%niso$ona.

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:ETAJOLS:O !E CORTCO!ES

Síntesis de Corticoides

S" sKnt*sis *&)i*4a (on *$ (o$*st*ro$ ,"* $o intro%"(*n *n $a (@$"$a ' $oa$&a(*nan *n for&a %* #otitas. Po(o a )o(o s* $* aBa%*n (osas a $as #otas.

a' tr*s )asos (rKti(osC"an%o $a &o$@("$a to&* "n O *n )osi(in 111G ' 21.Estos hi%ro7i$a(oin*s$as $$*Han a (ao $as hi%ro7i$asas 111G ' 21. *stas tr*s *n4i&as )*rt*n*(*n a $a fa&i$ia%* $os (ito(ro&os CI0 ' son &"' )ar*(i%as *ntr* sK.

Co$*st*rina S*7o(orti(oi%*sPro#n*o$ona 17 alfa OH hidroxilado

Pro#*st*rona

21 beta OH hidroxilado

11-Desoxicorticosterona 11desoxicortisol An%r#*nos

11 beta OH hidroxilado

Corti(ost*rona Cortiso$ Estr#*nos

Aldosterona Mineralocorticoides 8$"(o(orti(oi%*s S*7o(orti(oi%*s

Patología: SKn%ro&* An%ro#*nita$M o i)o)$asia s")rarr*na$MS* )ro%"(* ant* $a fa$ta %* 21 i%o7i$asa 5 so$o s* )"*%*n for&ar

S*7o(orti(oi%*s. Por $o ,"* no s* sint*ti4a Cortiso$ a$ no sint*ti4ars* Cortiso$ $ahi)fisis fari(a &"(ho ACT )ara ,"* s* fari,"* )*ro no s* for&ara ' s* s*#"irnfor&an%o &s S*7o(orti(oi%*. Ant* $a )r*s*n(ia %* tanta hor&ona s*7"a$ &as("$inas*for&ar "n niBo-niBa &"' Hiri$i4a%os.Es *$ sKn%ro&* &s (o&<n.

No s* for&a na%a %* #$"(o(orti(oi%*s ' &in*ra$o(orti(oi%*s *s )or *sto ,"* ta&i@n s*$$a&a Pi*r%* Sa$M a$ )*r%*rsa$*s )or orina a$ no t*n*r &in*ra$o(orti(oi%*s.

E$ %@fi(it %* 1G i%ro7i$asa *s )o(o (o&<n.

Si s* %a *$ %@fi(it %* $a 11 i%ro7i$asa *$ (aso no *s tan #aH* (o&o $a )@r%i%a %*sa$ 'a ,"* s* $$*#an a for&ar 11-!*so7i(ortti(ost*rona ' 11-!*so7i(ortiso$ ,"* son&in*ra$o(orti(oi%*s. En *st* (aso a"&*nta $a Pr*sin art*ria$ ' *n *$ (aso ant*rior %is&in"'*.

Corti(oi%*s 3



Christian Prof. Rosa 21/22 -03-06 SNTESS = ACT!*hi%ro*)ian%rost*rona S*7o(orti(oi%* &s i&)ortant*. Es "n An%r#*no.

Los *st*roi%*s no s*a$&a(*nan.

E$ ACT s* a(tiHa )or &*%io%*$ A:P(.

CORTCO!ES EN SAN8REa' "n &7i&o a $as %* $a &aBana ' "n &Kni&o a $as %* $a tar%*. Est*

(ir("ito (ir(a%iano (oin(i%* (on *$ %*$ A:PC.Las )r"*as %* Cortiso$ s* ha(*n a $as %* $a &aBana a.&.D

NiH*$*s (orr*(tos Cortiso$10-1 &i(ro#/%$.Es inso$"$* *n a#"a ' )or tanto s* "n* a trans)ortina )ara (ir("$ar )or san#r*

)*ro "na )*,"*Ba )art* s* "n* a otras )rot*inas.

CATAJOLS:O !E CORTCO!ES 5S* %*str"'*n (on r*a((ion*s ,"* a ata(an a *$*&*ntos i&)r*s(in%i$*s.

R*a((in ,"K&i(a ,"* ata(a a$ )ri&*r ani$$o s"(*%* *n 2 *ta)as. S* in(or)oranI *n 2 *ta)as.

Los 2 )ri&*ros s* aBa%*n ,"itan%o *$ %o$* *n$a(* *ntr* I- !ihi%ro(ortiso$ o!ihi%ro(orti(oi%*.

L"*#o s* "n*n otros 2 "no *n @$ ' otro *n *$ ,"* h*&os %i(hoT*trahi%ro(orti(oi%* o T*trahi%ro(ortiso$.

Ahora *st* t*trahi%ro(ortiso$

s* (on+"#a (on (i%o#$"("rni(o )ara ,"* )"*%asa$ir a $a san#r* si*n%ohi%roso$"$*. S* *$i&ina )or $a orina. Est* (atao$ito %*(ortiso$ *s *$ I0 %* $o ,"*s* *$i&ina Cortisona.

a' otros (atao$itos )ara*$$o s* )on* o (a&ia *n *$(arono 11 "n #r")o (*tni(o

' ta&i@n s* )"*%* ha(*r *n*$ Carono 1G.

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22/03/068LUCOCORTCO!ES

S" a((in (*ntra$ *s &*tao$i4ar #$"(osa ' s* ha(* *n *$ hK#a%o h*)ato(itosD

La f"n(in %*$ (ortiso$ *s a"&*ntar $a *f*(tiHi%a% %* $a #$"(on*o#@n*sis (r*a

#$"(osa a )artir %* a&ino (i%os ' #$i(*ro$ #rasaMD fari(an #$"(osa ' $a Hi*rt*n asan#r* )ro%"(i*n%o hi)*r#$"(*&ia.

8$"(on*o#@n*sis n*(*sita s"stratos )ara $$*Hars* a (ao ' $os#$"(o(orti(oi%*sha(*n ,"* $os s"stratos Ha'an a$ hK#a%o. Cortiso$ )ro%"(* )rot*o$isisasK a"&*nta $a (on(*ntra(in %* a&ino (i%os *n san#r* ' s*rn (a)ta%os )or *$ hK#a%o

)ara $a #$"(on*o#@n*sis.

La sKnt*sis )rot*i(a s* fr*na )ir,"* ni a&ino (i%os ni #$"(osa *ntran *n $a (@$"$a )or,"* *$ (ortiso$ ti*n* *f*(to antiins"$Kni(o. AsK a"&*nta $i)$isis ' %is&in"'*$i)o#@n*sis.

Panora&a %o&ina%o )or #$"(on*o#@n*sis.Si ha' )o(as )rot*inas a$an(* nitro#*na%o n*#atiHo *s &a$o.Si *f*(to int*nso ' )ro$on#a%o *s &a$o

E9ECTOS 9AR:ACOL8COS8ran%*s (anti%a%*s %* Cortiso$ %"rant* $ar#o ti*&)o )ro%"(* *f*(to trfi(o.

Esto *s ,"* *n *$ t*+i%o a%i)oso s* )i*r%* )art* %*$ &is&o ' si $a )*r%i%a *s notoria a$fina$ *$ t*+i%o a%i)oso s* r*%istri"'* Entr* $os 2 ho&o)$atos ' *$ a%o&*n.

Corti(oi%*s




A((ion*s #*n*ra$*sTo%as $as (@$"$as r*s)on%*n a$ (ortiso$. A%*&s ha' &"(has a((ion*s *n $as ,"*

*$ (ortiso$ a(t<a (o&o int*r&*%iario son ACCONES PER:SAS. Por *+*&)$o $as(at*(o$a&inas no a(t<an *n a"s*n(ia %* (ortiso$.

E$ a"&*nto %* $a asor(in %* Ca$(io *s r*$*Hant* *n int*rior )or,"* %*s&in*ra$i4a $osh"*sos.A %osis a+as fisio$#i(as *$ (ortiso$ ti*n* )o(o *f*(to &in*ra$o(orti(oi%*Jron,"ios *f*(to )*r&isiHo %* (at*(o$a&inasEf*(to antiinf$a&atorio5 o("rr* *n $a san#r* so$o a"&*nta *$ n<&*ro %* h*&atK*s 'n*"trfi$os &i*ntras ,"* *$ r*sto %* fa&i$ias %is&in"'*.Antiinf$a&atorio – in&"nos")r*sor.

Lo &s i&)ortant* %* $a

a((in antiinf$a&atori *s ,"*r*%"(*n &ono(itos '%*sa)ar*(*n *osinfi$os. Los$info(itos %is&in"'*n *nn<&*ro ' s* a("&"$an *n4onas inf$a&atorias. Lasr*a((ion*s &*%ia%as )or hista&ina %*sa)ar*(*n.Esf*ra %* r*)"*stain&"nitaria.La *nf*r&*%a% %*a"toa#r*sin s* r*%"(* ant*$a *7)osi(in a niH*$*s %* %*$

(o&)$*&*nto &*nor*s a $o nor&a$.

a' s"stan(ias ,"* %*+an %*fari(ars* ,"* int*rHi*n*n *n

inf$a&a(in o *n )ro(*sos %*sist*&a in&"n*Ci($oo7i#*nasa 2

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Pot*n(ias %* a((in

E9ECTO ANTN9LA:ATORO = E9ECTO :NERALOCORTCO!E

Ef*(to &in*ra$o(orti(oi%* (on$$*Ha $a r*t*n(in %* $K,"i%os (on *$ (ons*("*nt*a"&*nto %* $a Pr*sin art*ria$ )or $o ,"* *s "n *f*(to ,"* %**&os int*ntar *Hitar.

E$ (ortiso$ ' $a (ortisona ti*n*n *f*(tos &"' )ar*(i%os.En r*$a(in (on $a a$%ost*rona *$ (ortiso$ ti*n* 200 H*(*s &*nos *f*(to&in*ra$o(orti(oi%*.

Entra *n (onta(to (on (on#$o&*ra%o %* )rot*inas *n (itoso$ Cortiso$ C8R8RE E$*&*ntos %* r*s)"*sta a #$"(o(orti(oi%*s

A%*&s %* 8RE ha' :R ,"* *s *$ r*(*)tor %* &in*ra$o(orti(oi%*s(on *$ ,"* *n(a+a $aa$%ost*rona )*ro *$ (ortiso$ ,"* *n(a+a (on 8RE ta&i@ns* "nirKa a :R' $o ha(* (on $a&is&a afini%a% ,"* $a a$%ost*rona.

En $as (@$"$as ,"* ha' :R to%o *$ (ortiso$ *s ata(a%o )or *$ 11Q hi%ro7i

*st*roi%* !*shi%ro#*na%a ' )asa %* (ortiso$ a (ortisona &*%iant* "na r*a((inr*H*rsi$*.

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Christian Prof. Rosa 21/22 -03-06 S* int*nta ,"* (oriso$ no s* "na a :R )or,"* (o&o ha' &"(ho (ortiso$ harKa "na"&*nto %* r*t*n(in %* $K,"i%os ' a"&*nta $a Pr*sin art*ria$. Esto o("rr* si *$ *n4i&afa$$a 8$i(irri(ina o (i%o #$i(irrKni(o inhi* *$ *n4i&a 11Q %*shi%ro#*na%a.8$i(irri(ina ha' *n r*#a$i4.

RE8ULACN

S*(r*(in %* Cortiso$ ACT i)fisi,"* *stD (ontro$a%a )or CR hi)ot$a&oD ' s* (i*rra )or (ortiso$*n

san#r* fr*na niH*$*s %*ACT ' *st* CR. Esto&ant*n%rKa $os niH*$*s %*s*(r*(in *sta$*s )*ro *stono *s asK. =a ,"* *$ rit&o(ir(a%iano i&)"*sto )or $astasas %* ACT %*$ sist*&a

$K&i(o.2 Cir("nstan(ia )i,"itos %*ACT9ina$&*nt* a"&*nto *$(ortiso$ *n sit"a(in %* *str@sfKs*(o a$ a(t"ar )or for&a(inr*ti("$ar.Estr@s )sK,"i(o a&i#%a$ahi)ot$a&o.

Corti(oi%*s




9SOPATOLO8?A ESCESOS = !E9ECTOS

%* (a%a 10 &@%i(os s* )asa *n $a a%&inistra(in )ara fr*nar $os sKnto&as ' o("rr*cushing yatogenico .La fa$ta %* )ro%"((in %* (ortiso$ o("rr* *n $a *nf*r&*%a% %* A%%ison ,"* s"(*%* )or $a

fa$ta %* Harias or&onas.

Corti(oi%*s F

s21 a Cortezasuprarreal

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