The body's 'alarm' to save you during stress: Let's simply learn about the Adrenal Medulla!

Imagine that you are walking down the street and suddenly a dog jumps up. Or you are about to take an important exam. Your heart rate suddenly increases, you sweat, your eyes widen, and your whole body suddenly goes into high alert, right? A small but very powerful part of your body instantly prepares you for such an emergency or stress. Today we are talking about the 'emergency response center' in our body, the Adrenal Medulla.

What is the Adrenal Medulla? Where is it located?

Simply put, the Adrenal Medulla is the innermost part of the Adrenal Glands in our body. Like the pit of a mango, the Medulla is the inner core of the Adrenal Gland. The Adrenal Glands are two small glands that sit on top of our kidneys, like two hats.

The adrenal gland is divided into two main parts:

1. Adrenal Cortex: This is the largest part of the gland, located on the outside.

2. Adrenal Medulla: This is the small part inside the gland that we are talking about today.

These two parts produce different types of hormones. The adrenal medulla mainly produces hormones that control our autonomic nervous system. The autonomic nervous system is the system that controls things that we don't consciously control, such as heart rate, breathing, and sweating. So the role of the adrenal medulla is very important.

What big deal is this small part making?

The main function of the Adrenal Medulla is to respond to stress . That is, to prepare our body to deal with a dangerous or emergency situation. We call this the 'Fight-or-Flight' response . In Sinhala, it means "fight-or-flight response".

Imagine if you were walking alone on the street at night and felt like someone was following you, what would happen to your body?

• The heart rate suddenly increases.
• Breathing rate increases.
• The pupils of the eyes become larger and vision becomes sharper.
• More blood flows to the muscles of the limbs, giving them the energy needed to run or fight.
• The feeling of pain is temporarily reduced.

All of this happens within seconds because of a group of hormones called catecholamines, which are released by the adrenal medulla. These are what activate our body's 'emergency alert'.

There are two main types of catecholamines:

1. Adrenaline - Another name for this is Epinephrine .

2. Noradrenaline - Another name for this is Norepinephrine .

Let's take a closer look at the function of these two hormones.

What is the structure of the Adrenal Medulla?

This small organ has a special structure to do its job properly.

• Blood supply: The adrenal medulla has a very large blood supply. This is because the hormones released in an emergency need to be sent throughout the body very quickly. It receives blood from branches that come from large blood vessels such as the abdominal aorta.
• Nerve supply: The medulla receives signals from the greater splanchnic nerve, which is part of our autonomic nervous system. When the brain receives the signal "Danger, act now!", the medulla is stimulated through this nerve.
• Chromaffin cells: These are the most specialized type of cells in the adrenal medulla. These cells contain small granules filled with the hormones adrenaline and noradrenaline. When a nerve signal arrives, these cells release their hormone packets directly into the bloodstream.

What problems can occur in the Adrenal Medulla?

Adrenal medulla disorders are very rare , but they can be life-threatening if they occur. Most of these problems are caused by tumors that develop in the medulla. Most of these tumors are non-cancerous (benign). Sometimes they can be inherited.

Here are some of the main types of lumps that can be seen.

What are the symptoms of this type of problem?

Many of these tumors grow very slowly, so they may not cause any symptoms in the early stages. Sometimes, they are found incidentally during a CT or MRI scan for another condition (adrenal incidentaloma) .

However, when a tumor starts to secrete too many hormones, symptoms can occur. Especially for someone with a tumor like a pheochromocytoma , the body's response to even normal stress can be exaggerated. Sometimes, even something as simple as bending over or eating certain foods can cause dangerous symptoms. We call this a hypertensive crisis .

Symptoms that may occur in such a crisis are:

• Severe headache
• Chest pain
• Excessive sweating (hyperhidrosis)
• Difficulty breathing (dyspnea)
• Nausea and vomiting
• Heart palpitations
• Loss of consciousness (syncope)
• Seizures

If symptoms like these occur suddenly, it is essential to go to a hospital's Emergency Treatment Unit (ETU) immediately .

Other conditions that can be caused by hormonal imbalance

Hormones released by the adrenal medulla (especially noradrenaline) are closely linked to our mood and mental health. Abnormally high levels of these hormones over a long period of time can contribute to some mental health problems.

Here are some such situations:

• Anxiety
• Depression
• Panic disorder
• Attention deficit hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)
• Addiction

This does not mean that all of these diseases are caused by a problem with the adrenal medulla. However, an imbalance in these hormones can cause or exacerbate these symptoms.

What are the treatments for these conditions?

Treatment options depend on your diagnosis and the severity of your symptoms. Your doctor will examine you and recommend the most appropriate treatment.

• Treatment for Hypertensive Crisis: Since this is an emergency, treatment is given in the hospital to quickly lower blood pressure. For this, drugs such as vasodilators (drugs that widen blood vessels) are given intravenously.
• Treatment for tumors and cancer: Most tumors require surgical removal. Sometimes one or both adrenal glands may need to be removed. If the tumor is cancerous, treatment such as radiation or chemotherapy may also be needed.

What should we do to keep the Adrenal Medulla healthy?

Keeping our entire body healthy is beneficial for the functioning of all organs, including the Adrenal Medulla. In particular, chronic stress can overwork this system and cause fatigue. Therefore, it is very important to take care of these things.

• An active lifestyle: Regular exercise goes a long way in managing stress.
• Nutritious diet: Eat a balanced diet of vegetables, fruits, and nutritious grains.
• Drinking enough water: Water is essential for all body functions.
• Stress management: Calm your mind through deep breathing exercises, meditation, and engaging in a hobby of your choice.
• Preventive Care: Go for regular medical checkups and take care of your physical health.

If you have any doubts or concerns about the symptoms mentioned in this article, please consult your doctor and discuss it . An endocrinologist, in particular, will provide you with the most accurate guidance.

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