Böbreküstü Bezleri. The adrenal glands. %g%5(.h67h %(=/(5ø1ø1 0$ ø. <$3,6,

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1 Böbreküstü Bezleri Dr. Elvan Özbek 1 %X odoõúpdgd E EUHN VW EH]OHULQLQ HPEUL\RORMLN JHOLúLPL LOH KHP PDNURVNRSLN KHP GH PLNURVNRSLN \DSÕVÕ KDNNÕQGDNL NODVLN ELOJLOHU YH VRQ OLWHUDW U YHULOHUL GHUOHQHUHN VXQXOGX >7XUJXW g]do 7ÕS 0HUNH]L Dergisi 1997;4(1): ] Anahtar Kelimeler: Böbreküstü bezleri, anatomi, histoloji, embriyoloji In this study, classical knowledge and recent literature related to embryological development and both macroscopic and microscopic structures of the adrenal were glands reviewed. [Journal of Turgut Özal Medical Center 1997;4(1): ] Key Words: Adrenal glands, anatomy, histology, embryology % EUHN VW EH]OHUL \DúDP LoLQ ]RUXQOX RODQ YH RUJDQL]PDQÕQ JHQHO IL]\RORMLN G ]HQLQL VD ODPDGD Lú J UHQ QHPOL ELU oliw HQGRNULQ RUJDQGÕU (1-15)2UJDQÕQ SDUDQNLPDVÕ PH]RGHUPGHQ N NHQ DODQ NRUWHNV YH HNWRGHUPDO ND\QDNOÕ PHGXOOD ROPDN ]HUH IDUNOÕ LNL E O PGHQ ROXúXU (4-21). Korteks hücreleri mineralokortikoidleri, glukokortikoidleri ve androjenleri, medulla hücreleri ise NDWHNRODPLQOHUL VDOJÕODPDODUÕQD ED OÕ RODUDN ELUELULQGHQ IDUNOÕ LúOHYH VDKLSWLUOHU *HQHO RODUDN korteks, adrenokortikotrop hormonun (ACTH) ve medulla, sempatik sinir sisteminin kontrolü DOWÕQGDGÕU $\UÕFD RUJDQL]PD LoLQ HQGRMHQ YH HNVRMHQ ELUoRN HWNHQ EX EH]LQ odoõúpdvõqõ G ]HQOHU (1-15) % \OH ohúlwol NRúXOODUOD ED ODQWÕOÕ YH orn \ QO odoõúdq RUJDQÕQ PLNURVNRSLN \DSÕVÕQÕQ IRQNVL\RQD GD\DOÕ GH LúLNOLN J VWHUPHVL NDoÕQÕOPD]GÕU %XQGDQ GROD\Õ EX EH]LQ JHOLúLPL QRUPDO YH\D GHQH\VHO KLVWRORMLN \DSÕVÕ SHN orn odoõúpd\d NRQX ROPDNWDGÕU %X QHGHQOH E EUHN VW EH]OHULQLQ HPEUL\RORMLN JHOLúLPL LOH PDNURVNRSLN YH PLNURVNRSLN \DSÕVÕQÕ NODVLNOHúPLú ELOJLOHU (1-21) \DQÕQGD OLWHUDW U YHULOHULQL GH (22-77) kapsayacak úhnlogh GHUOHPHN DPDoODQGÕ %g%5(.h67h %(=/(5ø1ø1 0$ ø. <$3,6, Böbreküstü bezleri (glandulae suprarenales, adrenal bez, suprarenal bez, sürrenal bez), insanda RQELULQFL WRUDNDO YHUWHEUDODU KL]DVÕQGD UHWURSHULWRQHDO RODUDN KHU ELU E EUH LQ VW NXWEXQXQ KDILI Lo WDUDIÕQD \HUOHúPLú ELU oliw HQGRNULQ RUJDQGÕU gq \ ] QGH VXSUDUHQDO YHQLQ YH OHQI GDPDUODUÕQÕQ oõnwõ Õ KLOXV DGÕ YHULOHQ ROXN úhnolqgh ELU JLULQWL YDUGÕU 6D GD Q \ ] Q VW NÕVPÕ NDUDFL HUOH DOW NÕVPÕ GXRGHQXPOD Lo NÕVPÕ YHQD NDYD LQIHULRUOD VROGD LVH Q \ ] Q VW NÕVPÕ EXUVD RPHQWDOLV DUDFÕOÕ Õ\OD PLGHQLQ DUND \ ] LOH DOW NÕVPÕ SDQNUHDV NX\UX X YH GDODN GDPDUODUÕ\OD NRPúXGXU øqvdqgd VD GD SLUDPLW VROGD \DUÕPD\ úhnolqgh RODQ EH]OHUGHQ KHU ELUL RUWDODPD [[ FP ER\XWODUÕQGDGÕU 7RSODP D ÕUOÕNODUÕ LQVDQGD JU DUDVÕQGD GH LúLU YH VROGDNL VD GDNLQGHQ GDKD D ÕUGÕU (1,6-15,19-21). Bununla birlikte büyüklük ve D ÕUOÕ Õ W UH \DúD FLQVL\HWH YH IL]\RORMLN GXUXPD J UH GH LúLNOLNOHU J VWHUPHNWHGLU (7,8,10,11). Bu konuda günümüze kadar birçok hayvan deneyleri 1 $WDW UN hqlyhuvlwhvl 7ÕS )DN OWHVL +LVWRORML(PEUL\RORML $QDELOLP 'DOÕ (U]XUXP 134

2 Özbek E. \DSÕOPÕúWÕU <DúÕQ LOHUOHPHVL\OH DGUHQDO EH]LQ D ÕUOÕ ÕQGD (22) YH E \ NO QGH (23), adrenal NRUWHNVLQ Lo NÕVPÕQGDNL K FUHOHULQ KHP VD\ÕVÕQGD hem de hacminde (7,24) DUWÕú ROGX X J VWHULOPLúWLU 'LúL VÕoDQODUÕQ (25-32) JHQo GLúL NRED\ODUÕQ (22), GLúL PRQJROLDQ JHUELOOHULQ (33) ve erkek "hamster"lerin (26,34) DGUHQDO EH]OHULQLQ D\QÕ \DúODUGDNL NDUúÕW FLQVL\HWWHNLOHULQ DGUHQDO EH]OHULQGHQ GDKD D ÕU YH\D E \ N ROGX X ELOGLULOPLúWLU 6ÕoDQODUGD EX IDUN SXEHUWH ]DPDQÕ WDP RODUDN JHOLúLPLQ NÕUNGRNX]XQFX J Q RUWD\D oõndu YH DGUHQRNRUWLNDO ]RQODUÕQ WRWDO KDFPL matürasyon boyunca dereceli olarak artar (25,26). +DPVWHUGH LVH NDUúÕW FLQVOHU DUDVÕQGDNL IDUN LON NH] JHOLúLPLQ \LUPLVHNL]LQFL J Q QGH J ]H odusdu (26,34). Genç kobaylarda gözlenen fark, seksüel \ QGHQ WDP ROJXQODúPÕú HUNHN YH GLúL NRED\ODU DUDVÕQGD J ]OHQPH] (22). "Mongolian gerbil"lerde LVH DGUHQDO EH]LQ DEVRO W D ÕUOÕ Õ LNL FLQVWH GH D\QÕ LNHQ U ODWLI EH] D ÕUOÕ Õ GLúLOHUGH GDKD ID]ODGÕU (33). $\UÕFD J Q P ]H NDGDU \DSÕODQ SHN orn ELOLPVHO DUDúWÕUPDGD HUNHN FLQVL\HW KRUPRQX RODQ WHVWRVWHURQXQ VÕoDQODUGD KLSRWDODPXVKLSRIL] DGUHQDO DNVÕQÕ LQKLEH HGLS (30,35) $&7+ VDOÕQÕPÕQÕ D]DOWWÕ Õ (36) DGUHQDO EH] D ÕUOÕ ÕQÕ G ú UG (31), DGUHQDO NRUWHNVLQ PLWRWLN LQGHNVLQL D]DOWWÕ Õ (27,37); HUNHN VÕoDQODUD RUúLHNWRPL X\JXODQPDVÕ VRQXFXQGD DGUHQDO EH] D ÕUOÕ ÕQÕQ DUWÕS (30,32), adrenal NRUWHNVLQ PLWRWLN LQGHNVLQLQ \ NVHOGL L (27,37); D\UÕFD GLúL FLQVL\HW KRUPRQX RODQ VWUDGLRO Q VÕoDQODUGD KLSRWDODPXVKLSRIL]DGUHQDO DNVÕQÕ stimüle ederek (30,36) KLSRIL]GHQ $&7+ VDOÕQÕPÕQÕ DUWÕUGÕ Õ (38), adrenal kortekste mitotik indeksi \ NVHOWWL L (27) DGUHQDO EH] D ÕUOÕ ÕQÕ DUWÕUGÕ Õ (31,32) GLúL VÕoDQODUD RYDU\HNWRPL X\JXODQPDVÕ VRQXFXQGD LVH DGUHQDO EH] D ÕUOÕ ÕQÕQ D]DOGÕ Õ (30,31) J VWHULOPLúWLU *HEH KDPVWHUOHUGH DGUHQDO EH]LQ DEVRO W YH U ODWLI D ÕUOÕ ÕQÕQ DUWWÕ Õ YH EH] D ÕUOÕ ÕQÕQ HQ \ NVHN GH HUH JHEHOL LQ EHúLQFL J Q QGH XODúWÕ Õ ELOGLULOPLúWLU (39,40). %g%5(.h67h %(=/(5ø1ø1 (0%5ø<2/2-ø. *(/øùø0ø *HQHOGH GL HU HQGRNULQ RUJDQODU JLEL ED GRNXVX ELU NDSV OD LOH VDUÕOÕ RODQ RUJDQ KLVWRORMLN RODUDN IDUNOÕ LNL SDUDQNLPDO E O P LoHULU %XQODU korteks (interrenal madde) ve medulla bölümleridir. + FUHOHULQLQ \DSÕVÕ G ]HQOHQLúL YH IRQNVL\RQX \ Q QGHQ ELUELULQGHQ IDUNOÕ RODQ PHGXOOD YH NRUWHNVLQ HPEUL\RORMLN JHOLúLPOHUL GH IDUNOÕGÕU (4-21) %X LNL NÕVÕP EDOÕNODUGD \DúDP ER\X ELUELULQGHQ D\UÕ RODUDN NDOÕU DPILELDODUGD \DQ\DQD GXUXU UHSWLOOHUGH YH NXúODUGD ELUELULQH NDUÕúPD\D EDúODU 0HPHOLOHUGH LVH KHU ELU EH] VDQWUDO \HUOHúLPOL PHGXOODGDQ YH EXQX SHULIHULN RODUDN NXúDWDQ NRUWHNVWHQ ROXúPXú WHN ELU RUJDQ KDOLQGHGLU (7,9,10,16)..RUWHNV ROXúXPX LQVDQGD G UG QF YH DOWÕQFÕ HPEUL\RQDO KDIWDODU DUDVÕQGD PPOLN embriyoda kölom epitelinin mezenter kökü ile JRQDG WDVODNODUÕQÕQ DUDVÕQGDNL E OJHGH or DOPDVÕ\OD EDúODU. ORP HSLWHOLQGHQ D\UÕODQ PH]RGHUPDO N NHQOL K FUHOHU DOWWDNL PH]HQúLP LoLQH GR UX LOHUOH\HUHN EXUDGD D\UÕ ELU K FUH WRSOXOX X ROXúWXUXUODU %X K FUHOHU DVLGRILO E \ N K FUHOHUH IDUNOÕODúDUDN RUJDQÕQ I WDO NRUWHNVLQL \DSDUODU (5,9,10,13,16-18). 0HGXOOD LVH HNWRGHUPDO ND\QDNOÕ ROXS NULVWD Q UDOLVWHQ ROXúDQ VHPSDWLN VLQLU VLVWHPLQLQ ELU SDUoDVÕGÕU (4-21) $RUWDQÕQ \DQÕQGDNL VHPSDWLN NRUGRQGDQ D\UÕODQ X]DQWÕVÕ] K FUHOHU (sempatikoblast, sempatogonia), embriyonal \DúDPÕQ DOWÕQFÕ KDIWDVÕ ER\XQFD NRUWHNV WDVOD ÕQÕQ \DQÕQD J o HGHUOHU 'DKD VRQUD VHPSDWLNREODVWODU NRUWHNV WDVOD ÕQÕQ LoLQH JLUPH\H EDúODUODU ) WDO NRUWHNV LOH NXúDWÕODQ VHPSDWLNREODVWODU or DOPD\D GHYDP HGHUOHU øqwudxwhulq \DúDPÕQ o QF D\ÕQD GR UX EX K FUHOHU VHPSDWLN JDQJOLRQ K FUHOHUL YH kromafin hücreler (feokromosit) olarak iki yönde IDUNOÕODúÕUODU (5,16). Kölom epitelinden köken alan mezodermal K FUHOHULQ DOWWDNL PH]HQúLP LoLQH J o HWPHVLQGHQ \DNODúÕN EHú KDIWD VRQUD \D GD EDúND ELU GH\LúOH intrauterin üçüncü ayda, kölom epiteli tekrar or DOPD\D EDúODU 2OXúDQ \HQL K FUHOHU GDKD N o N YH ED]RILOGLU %XQODU I WDO NRUWHNVH GR UX LOHUOH\HUHN RQX GÕúWDQ NXúDWÕU YH HVDV NRUWHNVL yaparlar. Böylece prenatal dönemdeki adrenal korteks, esas korteks ve fötal korteks olmak üzere LNL IDUNOÕ NÕVÕPGDQ ROXúXU (VDV NRUWHNVLQ K FUHOHUL VRQUDGDQ ]RQD JORPHUXOR]D\Õ YH ]RQD IDVLN ODWD\Õ yaparlar (16-18). %DúODQJÕoWD NRUWHNV JHQHO Y FXW E \ PHVL\OH RUDQWÕOÕ RODUDN KÕ]OD E \ U %H]LQ E \ NO insanda intrauterin dördüncü ayda böbrek E \ NO QH HULúLU *HEHOL LQ VRQ D\ÕQGD LVH E \ PHVL \DYDúODU (17). Mezodermal hücrelerin KÕ]OD or DOPDVÕ E \ N ELU RODVÕOÕNOD DUDODUÕQD JLUHQ VHPSDWLNREODVWODUÕQ X\DUÕFÕ HWNLVL\OH ROPDNWDGÕU %HúLQFL I WDO D\D NDGDU NRUWHNVLQ JHOLúLPL ED ÕPVÕ]GÕU %XQGDQ VRQUD LVH $&7+XQ NRQWURO DOWÕQD JLUHU (16). <HQLGR DQ LQVDQÕQ DGUHQDO PHGXOODVÕ D] JHOLúPLúWLU %XQODUGD HVDV NRUWHNV EH] Journal of Turgut Özal Medical Center 4(1):

3 Böbreküstü bezleri E. Özbek SDUDQNLPDVÕQÕQ \ ]GH VLQL LoHUHQ LQFH ELU KDOND úhnolqghglu =RQD JORPHUXOR]D NHVLQ \DSÕVÕQÕ ND]DQPDPÕúWÕU =RQD IDVLN ODWD LVH L\L JHOLúPLú ROXS I WDO NRUWHNVOH WHPDVWDGÕU (16) 'R XPGDQ VRQUD I WDO NRUWHNVWH KÕ]OÕ ELU JHULOHPH LQYRO V\RQ görülür (7,10,11,13,14,16,17). Bu dönemde fötal NRUWHNV K FUHOHULQLQ Q NOHXVODUÕQGD SLNQR] VLWRSOD]PDODUÕQGD \D OÕ GHMHQHUDV\RQ J U OG bildirilmektedir (16) $GUHQDO EH]LQ E \ NO \HQL GR PXúODUGD E EUH LQ owh ELUL LNHQ \HWLúNLQOHUGH yirmisekizde veya otuzda biridir (9,13,17). 'R XPGDQ VRQUDNL LON RQG UW J Q LoLQGH GR XP D ÕUOÕ ÕQÕQ owh ELULQL ND\EHGHQ RUJDQ LON G UW D\ÕQ VRQXQGD \DUÕ D ÕUOÕ ÕQD LQHU (13). Fötal kortekste gerileme olurken, zona glomeruloza ile fasikülata JHOLúPH\H GHYDP HGHUOHU YH EX VÕUDGD ]RQD UHWLN ODULV EHOLUPH\H EDúODU 'R XPGDQ VRQUDNL LNLQFL \DúWD I WDO NRUWHNV HQ GÕú WDEDNDVÕ KDULo WDPDPHQ RUWDGDQ NDONPÕúWÕU (16). Fötal korteksin en GÕú WDEDNDVÕQGDQ ]RQD UHWLN ODULV JHOLúLU (ULúNLQGHNL NRUWHNV \DSÕVÕQD LVH DQFDN SXEHUWH od ODUÕQGD XODúÕOÕU (16-18). Black VH (1972) kobayda intrauterin 24.ncü ve QFL J QOHU DUDVÕQGD NRUWLNDO EODVWHPGH Lo YH GÕú ROPDN ]HUH KLVWRORMLN \ QGHQ ELUELULQGHQ IDUNOÕ LNL E OJHQLQ D\ÕUW HGLOGL LQL YH N o N K FUHOL GÕú E OJHQLQ HULúNLQ ]RQD JORPHUXOR]DVÕQD EHQ]HGL LQL ELOGLUPHNWHGLU $\QÕ odoõúpdgd KLSHUSOD]L YH KLSHUWURIL VRQXFX JHQLúOL L DUWDQ GÕú E OJHGHQ IDUNOÕODúDQ K FUHOHU VD\HVLQGH Lo E OJHQLQ E \ NO Q Q JLGHUHN DUWWÕ Õ YH LQWDXWHULQ HOOLEHúLQFL J QGH E \ N K FUHOL Lo E OJHGHQ ]RQD IDVLN ODWD YH ]RQD UHWLN ODULVLQ IDUNOÕODúWÕ Õ EHOLUWLOPHNWHGLU % \OHFH HOOLEHú J QO N NRED\ I W V QGH DGUHQDO NRUWHNV o ]RQDGDQ ROXúPDNWDGÕU (41). Ultrastrüktürel olarak insan fötal korteks K FUHOHULQLQ VLWRSOD]PDVÕQGD VWHURLG VDOJÕOD\DQ hücreler için tipik olan bol granülsüz endoplazmik UHWLNXOXP 6(5 YH W E OHU NULVWDOÕ PLWRNRQGULOHU LOH E \ N RODVÕOÕNOD VWHURLG U QOHULQLQ V OIDWODQPDVÕQGDQ VRUXPOX ROGX X G ú Q OHQ YH orn VD\ÕGD JUDQ O LoHUHQ JHQLú *ROJL NRPSOHNVL EXOXQXU (13,41). Fötal korteksten dehidroepiandrosteron V OIDW VDOJÕODQGÕ Õ YH EXQXQ SODVHQWDGD DNWLI androjen ve östrojene çevrilerek annenin kan GRODúÕPÕQD JLUGL L ELOGLULOPHNWHGLU (6,11,13). (PEUL\RORMLN JHOLúPH VÕUDVÕQGD HVDV WDVODNOD LOLúNLOHUL NHVLOHQ NRUWHNV WRPXUFXNODUÕ DNVHVXDU DGUHQDO EH]OHUL ROXúWXUXUODU <HQL GR PXú erkeklerde funikulus spermatikus ve epididim ohyuhvlqgh NÕ]ODUGD LVH SOLND ODWD XWHUL LoLQGH YH RYDU\XP ohyuhvlqgh VDGHFH NRUWHNVWHQ ROXúPXú DNVHVXDU DGUHQDO EH]OHU EXOXQDELOLU )DNDW EXQODUÕQ E \ N NÕVPÕ DWURIL\H X UDU 0HGXOOD\Õ GD LoHUHQ DNVHVXDU EH]OHUH orn HQGHU UDVWODQÕU (9,16). %g%5(.h67h %(=/(5ø1ø1 +ø672/2-ø. <$3,6, (ULúNLQ PHPHOLOHUGH VDQWUDOGH PHGXOOD YH EXQX SHULIHULN RODUDN NXúDWDQ NRUWHNV E O POHULQGHQ ROXúPXú EH]OHULQ KHU ELUL HQ GÕúWDQ ED GRNXVX ELU NDSV OD LOH VDUÕOÕGÕU.DSV OD NROODJHQ OLIOHU LOH ILEURVLWOHUGHQ ]HQJLQ YH ROGXNoD NDOÕQGÕU.DSV ODGD ERO DUWHUL\DO D ODU YHQOHU OHQI GDPDUODUÕ YH VLQLU SOHNVXVODUÕ EXOXQXU $\UÕFD EXUDGD G ] NDV K FUHOHUL LOH WHN W N PDVWRVLWOHU GH YDUGÕU.DSV ODQÕQ Lo NÕVPÕQGD \HU DODQ N o N JUXSODU KDOLQGHNL indiferansiye hücrelerden, korteks hücrelerinin IDUNOÕODúWÕ Õ YH EXUDQÕQ VXENDSV OHU WUDQVIRUPDV\RQ E OJHVL VXENDSV OHU EODVWHP RODUDN DGODQGÕUÕOGÕ Õ bildirilmektedir. Transformasyon bölgesine, NDSV ODQÕQ KHPHQ DOWÕQGD \DQ\DQD GL]LOPLú KDOGH EXOXQDQ JORPHUXOR]D K FUHOHULQLQ GH GDKLO ROGX X söylenmektedir (7).DSV ODGDQ RUJDQÕQ LoLQH GR UX NROODJHQ OLIOHUGHQ YH or XQOXNOD UHWLNXOXP OLIOHULQGHQ ROXúDQ LQFH ED GRNXVX E OPHOHU JLUHU 5HWLNXOXP OLIOHUL NRUWHNVLQ GÕú NÕVÕPODUÕQGD E \ N K FUH JUXSODUÕQÕ JHYúHNFH NXúDWÕUNHQ Lo NÕVÕPODUGD K FUHOHU DUDVÕQD VRNXODUDN KHU K FUH\L ELU DUMLURILO OLI sepeti gibi sarar ve medullada tekrar büyük hücre JUXSODUÕQÕ ohyuhohu 0HGXOODGD NRUWHNVH RUDQOD GDKD ID]OD ED GRNXVX EXOXQXU g]hoolnoh JHQLú GDPDUODUÕQ ohyuhvlqgh NROODJHQ OLIOHU \HU DOÕU (6-15,19-21). Korteks Korteksin parankim hücreleri yanyana dizilerek K FUH N PHOHULQL YH\D K FUH NRUGRQODUÕQÕ ROXúWXUXUODU + FUH N PHOHULQLQ YH\D NRUGRQODUÕQÕQ DUDVÕQGD VLQ ]RLG NDSLOOHUOHU YH ED GRNXVX HOHPDQODUÕ EXOXQXU $QFDN NRUWHNVWH VWURPD D] PLNWDUGDGÕU.RUWHNV K FUHOHULQLQ G ]HQOHQLúLQH J UH NODVLN RODUDN o NRQVDQWULN WDEDND\D D\UÕOÕU a) Zona glomeruloza: (Q GÕúWD NDSV OD DOWÕQGD \HU DODQ LQFH ELU WDEDNDGÕU b) Zona fasikülata:.doõq RUWD WDEDNDGÕU c) Zona retikülaris: 0HGXOOD\D NRPúX HQ Lo NRUWHNV WDEDNDVÕGÕU (1,4,5-15,19-21). øqvdqgd WRWDO NRUWHNV KDFPLQLQ \ ]GH LQL ]RQD glomeruloza, yüzde 78'ini zona fasikülata ve yüzde VLQL ]RQD UHWLN ODULV ROXúWXUXU %LU ]RQGDQ GL HULQH 136

4 Özbek E. JHoLú GHUHFHOLGLU YH KLVWRORMLN NHVLWOHUGH NHVLQ ELU VÕQÕU J VWHULOHPH] (10,12,14). Zona Glomeruloza øqvdqgd \XYDUOD ÕPVÕ SROLJRQDO YH\D X]XQFD hücreler bir araya gelerek ya hücre kümelerini ya da LNL XoODUÕQGDQ E N OHUHN NDYLVOHU \DSDQ YH DOWWD zona fasikülata hücreleri ile devam eden hücre NRUGRQODUÕQÕ ROXúWXUXUODU + FUH N PHOHULQLQ RUWDVÕQGD HN]RNULQ VDOJÕ EH]OHULQGHNL JLEL O PHQ yoktur (6-15). )DUNOÕ KD\YDQ W UOHULQGHNL GH LúLN J U Q ú sebebiyle zona glomerulozaya, zona multiformis de denmektedir (7). + FUHOHULQ NR\X ER\DQDQ \XYDUODN Q NOHXVODUÕ ELU YH\D LNL Q NOHROXV LoHULU 6LWRSOD]PDODUÕ GL HU ]RQDODUGDNL K FUHOHULQ VLWRSOD]PDVÕQGDQ GDKD D]GÕU YH JHQHOOLNOH DVLGRILO ER\DQPDVÕQD NDUúÕQ \HU \HU bazofil materyal içerir. Zona fasikülata hücrelerine NÕ\DVOD VLWRSOD]PDGD N o N YH D] VD\ÕGD OLSLG GDPODODUÕ VHoLOLU 0LWRNRQGULOHU LQVDQGD X]XQFD NHPLULFLOHUGH LVH \XYDUODN úhnloolglu YH JHQHOOLNOH NULVWDODUÕ ODPHOODU WLSWHGLU *ROJL NRPSOHNVL VÕNOÕNOD Q NOHXVXQ NDQ GDPDUÕQD EDNDQ WDUDIÕQD ORNDOL]HGLU 6LWRSOD]PDGD L\L JHOLúPLú ELU 6(5 D Õ YDUGÕU Granüllü endoplazmik retikulum (RER) daha az EXOXQXU 6LWRSOD]PD orn VD\ÕGD VHUEHVW ULER]RP LoHULU 3OD]PD PHPEUDQÕ G ]J QG U IDNDW K FUHQLQ perivasküler alana bakan yüzeyinde ve birkaç K FUHQLQ NDUúÕODúWÕ Õ ELOHúNHOHUGH NÕYUÕPODU \DSDU YH\D PLNURYLOOXVODUÕ YDUGÕU (8-10,12-15). %D]Õ DUDúWÕUÕFÕODU LVH LQVDQGD ]RQD JORPHUXOR]DQÕQ Lo YH GÕú ROPDN ]HUH LNL WDEDNDGDQ ROXúWX XQX ELOGLUPLúOHUGLU %XQODUD J UH \XNDUÕGD DQODWÕODQ ]HOOLNOHU Lo ]RQD JORPHUXOR]D WDEDNDVÕQGDNL K FUHOHUH X\DU =RQD JORPHUXOR]DQÕQ GÕú NÕVPÕQGDNL K FUHOHU LVH GDKD N o N G ]HQVL] úhnlool YH NDSV OD\D J P O GXUXPGDGÕUODU %X K FUHOHULQ Q NOHXVODUÕ GD G ]HQVL] úhnloolglu 0LWRNRQGULOHU RYDO YH\D X]XQFD úhnlool N o N orn VD\ÕGD ROXS ODPHOODU NULVWDOÕGÕUODU 6(5 D] JHOLúPLúWLU 6LWRSOD]PDGD EROFD VHUEHVW ULER]RP EXOXQXU 5(5 L\L JHOLúPLúWLU *ROJL NRPSOHNVL VÕNOÕNOD Q NOHXVXQ \DQÕQGDGÕU 6LWRSOD]PDGD Lo ]RQD JORPHUXOR]DGDNL K FUHOHUGHQ GDKD D] VD\ÕGD ELUNDo N o N OLSLG GDPODVÕ YDUGÕU 3OD]PD PHPEUDQÕQGD VH\UHN RODUDN PLNURYLOOXVODU EXOXQXU.RPúX K FUHOHU DUDVÕQGD ]RQXOD DGKHUHQVH EHQ]HU \DSÕODU YDUGÕU 3DUDQNLPDO K FUH DGDFÕNODUÕ EHOLUJLQ ELU ED]DO PHPEUDQOD NXúDWÕOPÕúWÕU 0LWRNRQGULOHULQ ODPHOODU NULVWDOÕ 6(5XQ D] JHOLúPLú ROPDVÕ YH OLSLG GDPODODUÕQÕQ orn VH\UHN EXOXQPDVÕ QHGHQL\OH GÕú zona glomeruloza hücreleri, steroid sentezleyen hücrelerin morfolojik özelliklerini göstermez. Bu E OJH LQGLIHUDQVL\H NRUWLNDO HOHPDQODUÕ LoHUHQ ELU KDYX] RODUDN \RUXPODQÕU (42). $\UÕFD ]RQD JORPHUXOR]D K FUHOHULQLQ VLWRSOD]PDVÕQGD SHURNVL]RPODUD YH OL]R]RPODUD UDVWODQGÕ Õ OL]R]RPODUÕQ K FUHQLQ NDSLOOHU \ ] ER\XQFD N PHOHU ROXúWXUGX X (43,44) YH NRPúX K FUHOHULQ NDUúÕOÕNOÕ PHPEUDQODUÕ ER\XQFD GHVPR]RPODUÕQ EXOXQGX X ELOGLULOPHNWHGLU (44,45). Zona Fasikülata øqvdq DGUHQDO NRUWHNVLQLQ HQ JHQLú WDEDNDVÕGÕU %D]DQ LQVDQGD DGUHQDO NRUWHNVLQ ED]Õ E OJHOHULQGH zona glomeruloza bulunmayabilir. Böyle GXUXPODUGD ]RQD IDVLN ODWD KHPHQ NDSV ODQÕQ DOWÕQGDQ EDúODU (8,10). Kübik veya poligonal K FUHOHU PHGXOOD\D GR UX ÕúÕQVDO RODUDN ELUELULQH SDUDOHO X]DQDQ K FUH NRUGRQODUÕQÕ ROXúWXUXUODU %X K FUH NRUGRQODUÕ JHQHOOLNOH ELU YH\D LNL K FUH JHQLúOL LQGHGLUOHU YH ELUELUOHULQGHQ VLQ ]RLG NDSLOOHUOHUOH D\UÕOÕUODU %X WDEDNDQÕQ K FUHOHUL ]RQD JORPHUXOR]DQÕQNLOHUH RUDQOD GDKD E \ NW U 9H]LN OHU J U Q úwh VDQWUDO \HUOHúLPOL \XYDUODN Q NOHXVODUÕ YDUGÕU ønl Q NOHXVOX K FUHOHUH GH VÕNoD UDVWODQÕU (8-15). øqvdqgd ]RQD IDVLN ODWD K FUHOHULQLQ VLWRSOD]PDVÕ JHQHOGH DVLGRILO ER\DQÕU $QFDN ]HOOLNOH ]RQD JORPHUXOR]D\D \DNÕQ SHULIHULN NÕVÕPODUGDNL K FUHOHUGH GDKD orn ROPDN ]HUH sitoplazma yer yer bazofil cisimler içerir (10,14,15). 6LWRSOD]PDGD NROHVWHURO \D DVLWOHUL YH Q WUDO \D GDQ ROXúPXú ERO PLNWDUGD OLSLG GDPODFÕNODUÕ EXOXQXU + FUHOHULQ EX OLSLG LoHUL L VWHURLG \DSÕVÕQGDNL KRUPRQ VHQWH]L LoLQ NXOODQÕOÕU (10,13-15). =RQD IDVLN ODWDQÕQ owh LNL GÕú NÕVPÕQGDNL K FUHOHUGH orn VD\ÕGD OLSLG GDPODVÕ EXOXQXU 5XWLQ KLVWRORMLN WHNQLN VÕUDVÕQGD OLSLG LoHULN HUL\LS RUWDGDQ NDONWÕ Õ LoLQ K FUHOHU YDNXROO YH V QJHULPVL J U O UOHU %X QHGHQOH SHULIHULN NÕVÕPGDNL EX K FUHOHUH VSRQJLRVLW DGÕ GD YHULOLU )DVLN ODWDQÕQ owh ELU Lo NÕVPÕQGDNL K FUHOHU LVH OLSLGGHQ IDNLUGLU YH GDKD NR\X ER\DQÕU (6,7,12,14). Böylece K FUHOHULQ OLSLG LoHUL L YH ER\DQPDVÕ IDUNOÕ ROGX XQGDQ GROD\Õ ]RQD IDVLN ODWD\Õ Lo LQWHUQD YH GÕú HNVWHUQD RODUDN LNL WDEDND\D D\ÕUPDN P PN QG U $QFDN EX LNL E OJH DUDVÕQGD NHVLQ ELU VÕQÕU \RNWXU (6,13,42-45) $\UÕFD ED]Õ DUDúWÕUÕFÕODU içteki fasikülata hücrelerinin, periferik hücrelerden Journal of Turgut Özal Medical Center 4(1):

5 Böbreküstü bezleri E. Özbek GDKD E \ N ROGX XQX EHOLUWPHNWH YH ]RQD IDVLN ODWD LQWHUQD\Õ ]RQD IDVLN ODWD HNVWHUQD LOH ]RQD UHWLN ODULV DUDVÕQGD ELU JHoLú E OJHVL RODUDN WDQÕPODPDNWDGÕUODU (43,44). 6ÕoDQODUGD J U OG JLEL ED]DQ ]RQD JORPHUXOR]D LOH ]RQD IDVLN ODWD DUDVÕQGD OLSLG LoHUPH\HQ ELU JHoLú E OJHVL EXOXQDELOLU =RQD LQWHUPHGLD VXGDQRIRE ]RQ GHQHQ EX E OJHGH VÕN PLWR]ODUD UDVWODQÕU (8-10,12)..DU\RPHWULN odoõúpdoduod ]RQD IDVLN ODWDQÕQ GLúL VÕoDQODUGD HUNHNOHUGHQ GDKD JHQLú ROGX X (25) GLúL VÕoDQODUGD YH PRQJROLDQ JHUELOOHUGH ]RQD IDVLN ODWDGDNL K FUHOHULQ YH K FUH Q NOHXVODUÕQÕQ HUNHNOHUGHNLQGHQ GDKD E \ N ROGX X (28,33), erkek VÕoDQODUÕQ ]RQD IDVLN ODWD K FUHOHULQGH Q NOHXV VLWRSOD]PD RUDQÕQÕQ GLúLOHUGHQ GDKD E \ N EXOXQGX X (32), testosteronun fasikülatadaki K FUHOHULQ KDFPLQL N o OWW (31) ve nükleus- VLWRSOD]PD RUDQÕQÕ \ NVHOWWL L (32) RUúLHNWRPLGHQ sonra zona fasikülata hücrelerinde hipertrofi (30) ve Q NOHXVVLWRSOD]PD RUDQÕQGD G úph (32) ROXúXUNHQ RYDU\HNWRPL VRQXFXQGD DWURIL JHOLúWL L (30) J VWHULOPLúWLU %D]Õ DUDúWÕUÕFÕODU LVH \DúÕQ LOHUOHPHVL LOH ELUOLNWH zona fasikülata hücrelerinin hem hacminin hem de VD\ÕVÕQÕQ DUWWÕ ÕQÕ YH D\UÕFD EX K FUHOHUGH údúõuwõfõ ELU OLSLG GDPODVÕ ELULNLPLQLQ J ]OHQGL LQL ELOGLULUOHU (7,24). Ultrastrüktürel olarak zona fasikülata K FUHOHULQGH L\L JHOLúPLú 6(5 EXOXQXU 0LWRNRQGULOHU RYDO X]XQFD YH VÕNOÕNOD G ]HQVL] úhnlool ROXS W E OHU NULVWDOÕGÕU %LUELULQH SDUDOHO RODUDN G ]HQOHQPLú 5(5 VLVWHUQDODUÕQD UDVWODQÕU *ROJL NRPSOHNVL MXNVWDQ NOHHU \HUOHúLPOL YH L\L JHOLúPLúWLU 6LWRSOD]PDGD OL]R]RPODU YH mikroperoksizomlar bulunur (8,10,12-15). Ancak zona fasikülata internada SER'un çok daha iyi JHOLúPLú ROXS NDUPDúDVÕQÕQ DUWWÕ Õ YH PLWRNRQGULOHULQ GH GDKD SROLPRUIR] ROGX X J VWHULOPLúWLU (43,44) $\UÕFD IDVLN ODWD hücrelerindeki SER tübüllerinin ve mitokondrial NULVWDODUÕQ \ ]H\ Oo POHULQLQ GLúL VÕoDQODUGD HUNHNOHUGHNLQGHQ GDKD ID]OD ROGX X ELOGLULOPLúWLU (30) <DúOÕ ELUH\OHULQ ]RQD IDVLN ODWD K FUHOHULQGH tektük lipokrom (lipofussin) pigmenti görülür ve bu SLJPHQWLQ VD\Õ YH E \ NO GHULQGHNL K FUHOHUH GR UX DUWDU (8,10,42) + FUHOHULQ NDSLOOHU GXYDUÕQD NRPúX \ ]OHULQGHNL SOD]PD PHPEUDQÕQGD NÕVD PLNURYLOOXVODU YDUGÕU (14,42) $\UÕFD ]RQD IDVLN ODWD HNVWHUQDGD NRPúX K FUHOHU DUDVÕQGD GHVPR]RPODUÕQ YH JDSMXQFWLRQDO HOHPDQODUÕQ EXOXQGX X YH ]RQD IDVLN ODWD LQWHUQDGD JDSMXQFWLRQODUÕQ VÕNOÕ ÕQÕQ DUWWÕ Õ J VWHULOPLúWLU (43,44). Zona Retikülaris $GUHQDO NRUWHNVLQ HQ Lo WDEDNDVÕGÕU 6LQ ]RLG NDSLOOHUOHU LOH ELUELULQGHQ D\UÕODQ YH D úhnolqgh DQDVWRPR]ODúDQ K FUH NRUGRQODUÕQGDQ YH N PHOHULQGHQ ROXúXU (1,6-15,19,20). Hücreleri zona IDVLN ODWDQÕQ K FUHOHULQGHQ GDKD N o NW U YH Q NOHXVODUÕ GD GDKD NR\X ER\DQÕU (7,13-15,33). Zona IDVLN ODWDGDQ UHWLN ODULVH JHoLú GHUHFHOLGLU =RQD UHWLN ODULVLQ IDVLN ODWD NDWÕQD NRPúX K FUHOHUL fasikülata hücrelerine çok benzer (6,10,14,45). $QFDN PHGXOOOD\D GR UX LOHUOHGLNoH D\GÕQOÕN YH NDUDQOÕN K FUHOHU EHOLUPH\H EDúODU $\GÕQOÕN K FUHOHULQ Q NOHXVODUÕ VROXN ER\DQÕU.DUDQOÕN K FUHOHULQ VLWRSOD]PDVÕ GDKD NR\X Q NOHXVODUÕ KLSHUNURPDWLN YH E ] úp úw U (6,8-10,15). Bu iki K FUH WLSL DUDVÕQGDNL ER\DQPD IDUNOÕOÕ ÕQÕQ fizyolojik önemi kesin olarak bilinmemektedir. g]hoolnoh NDUDQOÕN K FUHOHU ROPDN ]HUH ]RQD retikülaris hücreleri bol miktarda lipofussin pigmenti içerir (6-15) $\GÕQOÕN YH NDUDQOÕN K FUHOHULQ D\QÕ UHWLN ODULV K FUHOHULQLQ IDUNOÕ IRQNVL\RQ YH JHOLúLP GHYUHOHULQH DLW J U QW OHUL ROGX X EHOLUWLOPHNWHGLU (9) %D]Õ RW UOHU LVH ]RQD UHWLN ODULVWHNL NR\X VLWRSOD]PDOÕ KLSHUNURPDWLN YH E ] úp ú Q NOHXVOX NDUDQOÕN K FUHOHUL GHMHQHUDWLI K FUHOHU RODUDN \RUXPODPDNWDGÕUODU (8,10-12) %D]Õ DUDúWÕUÕFÕODU GD ]RQD UHWLN ODULVLQ DGUHQDO EH]LQ GÕú ]RQODUÕQGDQ J ohghq \ÕSUDQPÕú HOHPDQODUÕQ \ÕNÕP \HUL JLEL Lú J UG Q ELOGLUPHNWHGLUOHU (46). Zona retikülaris hücrelerinde az miktarda lipid GDPODVÕ EXOXQXU %X QHGHQOH ]RQD IDVLN ODWD LQWHUQD LOH ELUOLNWH ]RQD UHWLN ODULV WD]H EH]GH oõsodn J ]OH NRUWHNVLQ GHULQ NÕVÕPODUÕQÕQ NDKYHUHQJL J U OPHVLQH sebep olur (44). Retikülaris hücrelerinin VLWRSOD]PDVÕ 6(5 LOH GROXGXU 6(5XQ VLWRSOD]PDGD JHYúHN ELU D ROXúWXUDQ ELUELULQH SDUDOHO W E OOHUL DUDVÕQGD PLWRNRQGULOHU OL]R]RPODU SHURNVL]RPODU NÕVD VLVWHUQDOÕ 5(5 YH VHUEHVW ULER]RPODU GD ÕOPÕúWÕU 0LWRNRQGULOHU SROLPRUIR]GXU W E OHU YH\D ODPHOODU NULVWDOÕGÕU + FUHOHUGH orn VD\ÕGD VHNRQGHU OL]R]RPODU EXOXQXU.RPúX K FUHOHU DUDVÕQGD JDSMXQFWLRQODU YDUGÕU (10,13-15,44). 'LúL VÕoDQODUGDNL 6(5 YH PLWRNRQGUL PHPEUDQ \ ]H\OHULQLQ HUNHNOHUGHNLQGHQ GDKD ID]OD ROGX X KHVDSODQPÕúWÕU (30). <DúODQPD LOH ELUOLNWH ]RQD UHWLN ODULVWH K FUH KDFLP YH VD\ÕVÕQÕQ DUWWÕ Õ K FUHOHUGH OLSLG GDPODVÕ ELULNLPLQLQ J U OG (24) YH \DúOÕ NRED\ODUGD ]RQD retikülarisin, tüm korteks hacminin yüzde 50'sini LúJDO HWWL L (23,47) bildirilmektedir. 138

6 Özbek E. =RQD UHWLN ODULVLQ \Dú DUDVÕ NDGÕQODUGD (7) YH GLúL PRQJROLDQ JHUELOOHUGH (33) D\QÕ \DúODUGDNL HUNHNOHUH NÕ\DVOD GDKD JHQLú ROGX XQX retikülaristeki hücre ve nükleus hacimlerinin GLúLOHUGH GDKD ID]OD ROGX XQX (33), nükleus- VLWRSOD]PD RUDQÕQÕQ HUNHN VÕoDQODUGD GLúLOHUGHQ GDKD \ NVHN EXOXQGX XQX YH RUúLHNWRPL LOH EX RUDQÕQ G úw Q (32) \LQH VÕoDQODUÕQ ]RQD UHWLN ODULV K FUHOHULQGH RUúLHNWRPL VRQXFX KLSHUWURIL RYDU\HNWRPL VRQXFX LVH DWURIL JHOLúWL LQL (30) J VWHUHQ SHN orn odoõúpd \DSÕOPÕúWÕU Erbengi T (1990) zona retikülariste kapillerler ohyuhvlqghnl ED]Õ K FUHOHUGH IDJRVLWR] \HWHQH LQLQ RODELOHFH LQGHQ V ] HGHUNHQ (8) ED]Õ DUDúWÕUÕFÕODU GD EX E OJHGH PDNURIDMODUÕQ EXOXQGX XQX bildirmektedirler (6,21,45). Magalhaes MM ve ark. LVH VÕoDQGD ]RQD IDVLN ODWD LOH ]RQD UHWLN ODULV VÕQÕUÕQGD YH ]RQD UHWLN ODULVH GD ÕOPÕú RODUDN ERO OL]R]RP LoHUHQ ELUNDo PDNURIDMÕQ EXOXQGX XQX EXQODUÕQ SHULYDVN OHU DODQODUGD YH SDUDQNLPDO K FUHOHU DUDVÕQGD \HU DOGÕ ÕQÕ RUúLHNWRPL YH VWURMHQ WHGDYLVLQLQ VÕoDQGD DGUHQDO PDNURIDM VLVWHPLQL DNWLYH HWWL LQL PDNURIDMODUÕQ WHN membranla çevrili yuvarlak granüllerinin Hematoksilin-Eozin ile kahverengi, "Periyodik Asit- 6FKLII 3$6 UHDNVL\RQX LOH SHPEH ER\DQGÕ ÕQÕ YH KLQW P UHNNHEL HQMHNWH HGLOGL LQGH LVH K FUHOHULQ VL\DK SDUWLN OOHUOH GROX RODUDN L]OHQGL LQL J VWHUPLúOHUGLU (48,49) $\UÕFD HOHNWURQ mikroskopik olarak ve peroksidaz reaksiyonuna J UH PRQRVLWOHULQ ]HOOL LQL WDúÕ\DQ EX mononükleer fagositlerin miyelojenöz orijinli ROGX X ELOGLULOPLúWLU (50). Memeli adrenal korteksinin bilinen bu üç WDEDNDVÕQÕQ \DQÕ VÕUD ED]Õ KD\YDQODUÕQ DGUHQDO EH]OHULQGH \DúDPODUÕQÕQ EHOLUOL G QHPOHULQGHNL ohúlwol IL]\RORMLN JHUHNVLQLPOHUGHQ GROD\Õ ROXúWX X G ú Q OHQ JHoLFL ]RQODU J U OPHNWHGLU (51). Faredeki "X-zone" (51-54) ve "possum" daki (trichosurus vulpecula) "special zone" (S.Z.) (51,53-55) adrenal kortekste görülen bu geçici ]RQODUGDQGÕU :HLVV 0 LOH +ROPHV 39 YH DUN \DSWÕNODUÕ odoõúpdodugd GH +RZDUG 0LOOHU WDUDIÕQGDQ :HLVV 0 YH DUN GD GH &KHVWHU -RQHV WDUDIÕQGDQ IDUH DGUHQDO bezindeki X-zonun erkeklerde puberteden sonra, GLúLOHUGH LVH ELULQFL JHEHOLNWH GHMHQHUDV\RQD X UDGÕ ÕQÕQ V \OHQGL LQL ELOGLUPHNWHGLUOHU (51,52,54).HUU YH DUN LVH ;]RQXQ ohúlwol DUDúWÕUÕFÕODU WDUDIÕQGDQ RUWD\D NRQDQ ]HOOLNOHULQGHQ söz etmekte ve böylece bu zonun her iki cinsiyetteki LPPDW U IDUHOHUGH J U OG Q HUNHNOHUGHNL postpubertal dejenerasyonunun testislerden VDOJÕODQDQ DQGURMHQOHULQ DUWPDVÕQD ED OÕ ROGX XQX ;]RQXQ ]RQD IDVLN ODWDQÕQNLOHUGHQ N o N RODQ YH DVLGRILO ER\DQDQ K FUHOHUGHQ ROXúXS PHGXOOD\Õ NXúDWWÕ ÕQÕ EX ]RQXQ HULúNLQ HUNHN IDUHOHULQ kastrasyonundan sonra sekonder olarak zona IDVLN ODWD LQWHUQDGDQ ROXúWX XQX YH D KLGURNVLVWHURLG GHKLGURJHQD] HQ]LPL LoHUGL LQL belirtmektedirler (53) +ROPHV YH DUN GLúL IDUHGH ;]RQXQ HQ JHQLú RODUDN \LUPLELULQFL YH RWX]LNLQFL J QOHU DUDVÕQGD J U O S VHNV KRUPRQODUÕ\OD YH ]HOOLNOH JHEHOLN VÕUDVÕQGD GHMHQHUH ROGX XQX V \OHPHNWHGLUOHU (52). S.Z.'un ise PHPHOLOHU LoLQGH VDGHFH SXEHUWH\H HULúPLú GLúL SRVVXPGD J U OG HULúNLQ HUNHN YH VHNV HO \ QGHQ LPPDW U GLúL SRVVXPGD JRQDGRWURSLQOHUOH LQG NOHQHELOGL L ]RQD IDVLN ODWD LOH ]RQD UHWLN ODULV DUDVÕQGD YH DVLPHWULN RODUDN PHGXOODQÕQ VDGHFH ELU NÕ\ÕVÕQGD \HU DOGÕ Õ E LOH G ROPDN ]HUH LNL W U K FUHGHQ ROXúPXú JHoLFL ELU DGUHQRNRUWLNDO ]RQ ROGX X ELOGLULOPHNWHGLU (51,53-55). Adrenal korteksin sitogenezi ve UHMHQHUDV\RQ \HWHQH L 0HPHOL DGUHQDO NRUWHNVLQLQ VLWRJHQH]L KDNNÕQGD LNL HVDV WHRUL YDUGÕU %LUL K FUH J o WHRULVL GL HUL zonal teoridir. Hücre göçü teorisine göre, zona JORPHUXOR]DGDQ GR DQ \HQL DGUHQRNRUWLNDO K FUHOHU sentripetal olarak zona fasikülataya göçederler ve sonra zona retikülariste dejenere olurlar. Zonal teoriye göre ise, her bir adrenal zonda kendi serbest EDNÕPÕQÕ GHVWHNOHPH\H \HWHUOL RUDQGD \DYDú ELU K FUH or DOPDVÕ YDUGÕU (6,56) $QFDN HOGH HGLOPLú ED]Õ VRQXoODU ]RQDO WHRULQLQ GR UXOX X ]HULQGH ú SKH X\DQGÕUPDNWDGÕU 1-En büyük parankimal mitotik aktivite, zona JORPHUXOR]DGD YH ]RQD IDVLN ODWDQÕQ GÕú NÕVPÕQGD gözlenir (56); 2-Hücre dejenerasyonu sadece zona retikülariste YDUGÕU (56); 3UHSXEHUWDO G QHPGH VÕoDQ DGUHQDO NRUWHNVLQGH \DSÕODQ RWRUDG\RJUDILN ELU odoõúpdgd \HQL ROXúDQ SDUDQNLPDO K FUHOHULQ VHQWULSHWDO J o L]OHQHELOPLúWLU (57); $&7+ LOH SURYDNH HGLOPLú ]RQD IDVLN ODWD hiperplazisinde, zona glomeruloza-dan kaynaklanan yeni parankimal hücrelerin sentripetal göçü ve bu HVQDGD ]RQD JORPHUXOR]DQÕQ Lo \DUÕVÕ LOH ]RQD IDVLN ODWDQÕQ owh ELU GÕú NÕVPÕQGD 6 ID]ÕQGDNL K FUHOHULQ VD\ÕVÕQGD DUWÕú ROGX X J VWHULOPLúWLU (56). $GUHQDO NRUWHNVLQ PH]RGHUPDO N NHQOL ROPDVÕ YH NDSV ODQÕQ PXOWLSRWHQW UHPH YH IDUNOÕODúPD Journal of Turgut Özal Medical Center 4(1):

7 Böbreküstü bezleri E. Özbek \HWHQH LQL VDNOÕ WXWPDVÕ DGUHQDO NRUWHNV WDEDNDODUÕQÕQ UHMHQHUDV\RQXQX VD ODU (8). Deney KD\YDQODUÕQGD DGUHQDO EH] JHULGH VDGHFH NDSV ODVÕ YH EXQD \DSÕúÕN ELUNDo K FUHVL NDODFDN úhnlogh oõnduõogõnwdq ELU V UH VRQUD NRUWHNV UHMHQHUH ROGX X KDOGH PHGXOOD \HQLGHQ ROXúPD] (10). Rejenerasyon VÕUDVÕQGD NDSV OD LOH ]RQD JORPHUXOR]D DUDVÕQGDNL VÕQÕUGD VXENDSV OHU EODVWHP YH NRUGRQODU \DSDQ korteks hücreleriyle sinüzoid kapillerler J VWHULOPLúWLU (7,8). 6ÕoDQODUGD WHN WDUDIOÕ DGUHQDO EH]LQ Lo NRUWHNV YH PHGXOOD NÕVÕPODUÕ oõnduõodudn XQLODWHUDO HQ NOHDV\RQ \DSÕODQ odoõúpdgd HQ NOHDV\RQGDQ VRQUDNL LON o J Q LoLQGH K FUHOHULQ VD\ÕVÕQGD D]DOPD KDFLPOHULQGH LVH DUWÕú J ]OHQPLú ROXS K FUH E \ PHVL PLWRWLN E O QPH\H KD]ÕUOÕN RODUDN GH HUOHQGLULOPLúWLU (Q NOHDV\RQGDQ VRQUDNL o QF YH \HGLQFL J QOHU DUDVÕ LVH SUROLIHUDWLI ID] ROXS EX G QHPGH K FUH VD\ÕVÕQGD DUWÕú J ]OHQPLúWLU (58). $GUHQDO NRUWHNVLQ UHMHQHUDV\RQX VÕUDVÕQGD HUNHQ G QHPGH PLQHUDORNRUWLNRLG VDOJÕVÕQÕQ \HWHUOL VHYL\HGH ROGX X VDSWDQÕU %XQD NDUúÕQ enükleasyondan sonra 1-2 hafta geçinceye kadar JOXNRNRUWLNRLG VDOJÕODQPDVÕ JHUoHNOHúPH] 6RQXo olarak rejenere bezde fonksiyonel olarak normal zona fasikülata ve retikülaris hücrelerine benzeyen hücreler, zona glomeruloza hücrelerinden IDUNOÕODúÕUODU (10). Medulla 6DQWUDO \HUOHúLPOL PHGXOOD EH] KDFPLQLQ \DNODúÕN \ ]GH XQX NDSODU (6,12,15,59). Korteks LOH PHGXOOD DUDVÕQGDNL VÕQÕU LQVDQGD JHQHOOLNOH G ]HQVL] ROXS NRUWLNDO K FUH NRUGRQODUÕ \HU \HU medulla içine girer (7-10,12,14) %XQD NDUúÕQ ELUoRN KD\YDQGD NRUWLNRPHGXOODU VÕQÕU NHVNLQ RODELOLU (8,10,14) 0HGXOODQÕQ E \ N RYDO YH\D SROLJRQDO hücreleri bir araya gelerek, kümeler ya da birbiriyle DQDVWRPR]ODúDQ NÕVD NRUGRQODU ROXúWXUXUODU + FUH N PH YH NRUGRQODUÕQÕQ DUDVÕQGD YHQ OOHU YH VLQ ]RLG tipte kapillerler bulunur (6,7,9-12,14). Medulla, \D\JÕQ ELU VLQLU D ÕQD VDKLSWLU YH SDUDQNLP K FUHOHULQGHQ EDúND WHN WHN YH\D N o N JUXSODU halinde bulunan birkaç sempatik ganglion hücresi de içerir (6,7,9,10,12,14,21). Retiküler lifler, medulla K FUHOHULQL NXúDWÕUODU YH NDQ GDPDUODUÕ LOH VLQLUOHUH desteklik yaparlar (6,10-12,14). Kollagen lifler ise E \ N GDPDUODUÕQ ohyuhvlqgh EXOXQXUODU (7,12). 3DUDQNLPDO K FUHOHULQ VLWRSOD]PDVÕ ED]RILO ROXS ince granüller içerir. Veziküler tipte büyük bir Q NOHXV EXOXQXU $\UÕFD LNL Q NOHXVOX K FUHOHUH GH UDVWODQÕU (6,9,12,14). Ultrastrüktürel olarak, VLWRSOD]PDGD \D\JÕQ 5(5 QRUPDO VD\ÕGD PLWRNRQGUL YH L\L JHOLúPLú *ROJL NRPSOHNVL YDUGÕU Ancak ultrastrüktürel düzeyde bu hücrelerin en göze odusõfõ ]HOOL L orn VD\ÕGD QP odsõqgd PHPEUDQOD ohyulol \R XQ JUDQ OOHU LoHUPHVLGLU (9-11,14,15). 0HGXOOD GRNXVX SRWDV\XP ELNURPDWOÕ VRO V\RQODUGD ILNVH HGLOGL LQGH SDUDQNLP K FUHOHUL kahverengi granüllerle dolu olarak görülür. 6LWRSOD]PLN JUDQ OOHULQ NURP WX]ODUÕ\OD NDKYHUHQJLOHúPHVLQH NURPDILQ UHDNVL\RQ EX reaksiyonu gösteren hücrelere de kromafin hücreler IHRNURPRVLW GHQLU 6ÕoDQ DGUHQDO PHGXOODVÕQÕQ \ ]GH Q NURPDILQ GRNXQXQ ROXúWXUGX X JHUL\H NDODQ NÕVPÕQ \ ]GH VLQL GDPDUODUÕQ \ ]GH 5' ini sinir dokusunun, yüzde 12' sini de interstisiyel GRNXQXQ NDSODGÕ Õ ELOGLULOPLúWLU (59). Kromafin reaksiyon, granüller içindeki katekolaminlerin krom WX]ODUÕ\OD RNVLGDV\RQX YH SROLPHUL]DV\RQX VRQXFX ROXúXU 0HGXOOD K FUHOHUL EHQ]HU úhnlogh SRWDV\XP L\RGDW JLEL EDúND RNVLGDQ PDGGHOHUOH GH UHDNVL\RQD JLUHUHN VDUÕHVPHU UHQJH ER\DQÕUODU L\RGDW reaksiyonu). Feokromositler, osmium asidi ile NDKYHUHQJL J P ú WX]ODUÕ\OD VL\DK DUMHQWDILQ UHDNVL\RQ IHUULN NORULWOH \HúLO 9XOSLDQ UHDNVL\RQX renkte görülürler (7-10,13,14) $\UÕFD.DPLOH ùhynl Mutlu yöntemine göre formalinde fikse edilen feokromositlerin içinde bol miktarda oksifil JUDQ OOHUL J UPHN RODVÕGÕU (9). Epinefrin (adrenalin) ve norepinefrin QRUDGUHQDOLQ LoHUHQ K FUHOHU RODUDN LNL\H D\UÕODQ feokromositler, histokimyasal, otofluoresans ve ultrastrüktürel özelliklerine göre de birbirlerinden IDUNOÕOÕNODU J VWHULUOHU 1RUHSLQHIULQ GHSROD\DQ K FUHOHU DUMHQWDILQ YH L\RGDW UHDNVL\RQODUÕQÕ J VWHULUOHU D]RNDUPLQH NDUúÕ D] LOJLOLGLUOHU YH DVLW fosfataz negatiftirler. Epinefrin depolayan hücreler LVH EXQODUÕQ WDP WHUVL ]HOOLNOHUH VDKLSWLUOHU (8,10). 1RUHSLQHIULQ GHSROD\DQODU RWRIOXRUHVDQ ROGXNODUÕ halde, epinefrin depolayanlar otofluoresan GH LOGLUOHU (8,10,60). Glutaraldehitle fikse edilen norepinefrin hücrelerinin granülleri, epinefrin depolayan hücrelerinkinden daha çok elektron \R XQ ROXS KHWHURMHQGLU HSLQHIULQ GHSROD\DQODUÕQ granülleri ise homojendir (8,10,13-15) $\UÕFD NURPDILQ UHDNVL\RQD ED OÕ RODUDN HSLQHIULQ GHSROD\DQ PHGXOOD K FUHOHULQLQ VDUÕNDKYHUHQJL WRQODUÕQGD QRUHSLQHIULQ GHSROD\DQODUÕQ LVH NR\X NDKYHUHQJL WRQODUÕQGD J U OG ELOGLULOPHNWHGLU (60). Feokromositlerin granüllerinde, NDWHNRODPLQOHULQ \DQÕVÕUD NURPRJUDQLQ GHQHQ VROXEO 140

8 Özbek E. ELU SURWHLQ NDWHNRODPLQOHUL ED OD\ÕFÕ SURWHLQ olabilir), ATP (adenozin trifosfat), divalent katyonlar (Ca, Mg) ve dopamini norepinefrine çeviren dopamin b-hidroksilaz enzimi bulunur (2,3,10-12,15) )HRNURPRVLWOHU D\UÕFD PDVW K FUHOHUL ve sindirim sistemindeki 5-HT (5- Hidroksitriptamin) içeren hücrelere benzer reaksiyonlar gösterirler (12). Epinefrin depolayan hücrelerde serotonin (61), norepinefrin depolayan hücrelerde ise histamin (62) EXOXQGX X J VWHULOPLúWLU.RUGRQODU úhnolqgh G ]HQOHQHQ IHRNURPRVLWOHULQ ELU \ ] NDSLOOHUH GL HU \ ] YHQ OH EDNDU (6,7,12,14). Feokromositler, damarlarla olan LOLúNLOHULQH J UH VLWRSOD]PLN NXWXSODúPD J VWHULUOHU 1 NOHXV NDSLOOHUH VDOJÕ JUDQ OOHUL LOH *ROJL NRPSOHNVL LVH YHQ OH \DNÕQ WDUDIWDGÕU 3UHJDQJOLRQHU VHPSDWLN VLQLU OLIOHUL GH NDSLOOHUH NRPúX RODQ WDUDIWDQ K FUH\H HULúLU (6,12) $GUHQDO PHGXOODQÕQ VDOJÕ K FUHOHUL ELUoRN \ QGHQ SRVWJDQJOLRQLN nöronlara benzerler. Her ikisi de nöral kristadan JHOLúLU SUHJDQJOLRQLN VLQLU OLIOHUL\OH X\DUÕOÕU YH QRUHSLQHIULQ VDOJÕODUODU (12,13) %XQD NDUúÕQ Q URQODUGDQ IDUNOÕ RODUDN IHRNURPRVLWOHULQ DNVRQ YH dendritleri yoktur (11). Postganglionik nöronlarda QRUHSLQHIULQLQ HSLQHIULQH G Q ú P JHUoHNOHúWLULOHPHGL L KDOGH (12,13), adrenal PHGXOODGDNL NDWHNRODPLQ LoHUL LQLQ \ ]GH LQL HSLQHIULQ ROXúWXUXU (2,3,11,12) 1 URQODU VDOJÕODUÕQÕ VLQLU VRQODQPDODUÕQD ERúDOWÕUODU IHRNURPRVLWOHU LVH VDOJÕODUÕQÕ K FUHOHUDUDVÕ ERúOX D YHULUOHU YH EXUDGDQ GD KRUPRQODU NDQ GDPDUODUÕQD JHoHU (13) $\UÕFD fötüsde (63) YH \HQLGR DQGD (64) mitotik aktivite J VWHUHQ PHGXOODQÕQ NURPDILQ K FUHOHUL Q URQODUGDQ IDUNOÕ RODUDN HULúNLQ G QHPGH GH E O QPH \HWHQH LQL VDNOÕ WXWDUODU (65). 6HPSDWLN Q URQODUÕQ JOLDO K FUHOHUOH NXúDWÕOPDVÕQD EHQ]HU úhnlogh DGUHQRPHGXOODU kromafin hücreler de, glial hücrelere benzer ]HOOLNOHUH VDKLS K FUHOHUOH ohyuhohqplúwlu (66,67). Bu glia benzeri hücrelere, destek (supporting) hücreleri (66) veya satellit hücreler (67,68) denir. Sinir sistemine özgü olan ve nöronlarda bulunmayan S-100 proteininin hem sempatik ganglion satellit K FUHOHULQGH KHP GH DGUHQDO PHGXOODQÕQ VDWHOOLW K FUHOHULQGH EXOXQPDVÕ LNL K FUH WLSL DUDVÕQGDNL EHQ]HUOL H LúDUHW HGHU (67,68). Destek hücrelerinin N o N \DVVÕ KDILI X]XQFD YH KHWHURNURPDWLQGHQ ]HQJLQ Q NOHXVX YDUGÕU 'HVWHN K FUHOHUL PHGXOODQÕQ \ ]H\VHO NÕVPÕQGD Lo NÕVPÕQD RUDQOD GDKD VÕNWÕU YH QRUHSLQHIULQ K FUHOHULQL LoHUHQ E OJHOHUGH HSLQHIULQ K FUHOHULQLQ EXOXQGX X bölgelerden daha çok görülür (66). Adrenal medullada kromafin ve destek K FUHOHULQGHQ EDúND GDKD D] VD\ÕGD N o N OHQIRVLW EHQ]HUL K FUHOHU LOH VLWRSOD]PDVÕ ID]OD RODQ YH VIHULN RYDO DWQDOÕ YH\D E EUHN úhnolqgh Q NOHXVX bulunan serbest hücreler görülür. Serbest hücreler, ED]DO ODPLQDVÕ ROPD\DQ K FUH PHPEUDQÕQGD W E OHU LQYDJLQDV\RQODU EXOXQDQ orn VD\ÕGD OL]R]RPDO \R XQ FLVLPFLNOHU LoHUHQ PDNURIDM EHQ]HUL hücrelerdir (66). $\UÕFD DGUHQDO PHGXOODGD LPPXQRUHDNWLI&5) NRUWLNRWURSLQ VDOJÕODWÕFÕ IDNW U K FUHOHULQLQ ROGX X J VWHULOPLúWLU (69,70). Bunlar adrenal medulladaki NDQ GDPDUODUÕQÕQ \DNÕQÕQGD YH PHGXOOD LOH NRUWHNV DUDVÕQGDNL VÕQÕUGD orn EXOXQXUODU (70). Adrenal YHQ ] NDQGD &5) EXOXQPDVÕ EX KRUPRQXQ DGUHQDO EH]GHQ GH VDOJÕODQGÕ ÕQÕ GHVWHNOHPHNWHGLU (70). +HPRUDML YH VSODQNQLN VLQLU X\DUÕVÕQD \DQÕW RODUDN DGUHQDO &5) VHNUHV\RQXQXQ DUWWÕ Õ J VWHULOPLúWLU (70,71). CRF'ün direkt adrenal bezden kortikosteron VDOJÕODQPDVÕQÕ DUWÕUÕFÕ HWNLVLQLQ (72-75), KLSRWDODPXVKLSRIL] HWNLOHúLPLQH EHQ]HU úhnlogh ELU LQWUDDGUHQDO &5)$&7+ PHNDQL]PDVÕQÕQ YDUOÕ ÕQD ED OÕ RODELOHFH L (73) söylenip, ACTH'un lokal olarak intraadrenal lökositlerde ve medullar NURPDILQ K FUHOHUGH UHWLOHELOHFH L (74) belirtilmektedir. Fonksiyonel olarak hipofizektomi \DSÕODQ KD\YDQODUGD VSODQNQLN VLQLU X\DUÕVÕ VRQXFX DGUHQDO LPPXQRUHDNWLI$&7+ VHNUHV\RQXQXQ DUWWÕ Õ J VWHULOPLúWLU (76) $\UÕFD LQVDQ SHULIHUDO O NRVLWOHULQLQ VHQWHWLN &5) LOH X\DUÕOPDVÕ VRQXFX immunoreaktif-acth ve -POMC SURRSLRPHODQRNRUWLQ VHQWH]OH\HELOGL L RUWD\D NRQPXúWXU (77). %g%5(.h67h %(=/(5ø1ø1 '$0$5/$5, 9( 6ø1ø5/(5ø %X RUJDQ NDQ GRODúÕPÕ \ Q QGHQ ROGXNoD ]HQJLQGLU %H]LQ \ ]H\LQGHNL GH LúLN QRNWDODUGDQ birçok arter içeri girer. Üç ana grupta toplanan arterlerden süperior suprarenal arter, inferior frenik arterden; orta suprarenal arter, abdominal aortadan; LQIHULRU VXSUDUHQDO DUWHU UHQDO DUWHUGHQ GR DU $UWHUOHU NDSV ODGD ELU SOHNVXV ROXúWXUXUODU %X kapsüler pleksustan köken alan kortikal arterler, NRUWHNVLQ SDUDQNLPDO K FUH NRUGRQODUÕ DUDVÕQGD LOHUOH\HQ YH ELUELUL\OH DQDVWRPR]ODúDUDN ELU GDPDU D Õ ROXúWXUDQ VLQ ]RLG NDSLOOHUOHUL YHULUOHU.RUWHNVWH D\UÕFD ELU YHQ ] VLVWHP \RNWXU.RUWHNVLQ VLQ ]RLG NDSLOOHUOHUL NRUWLNRPHGXOODU VÕQÕUGD PHGXOODQÕQ kapillerlerine ve venüllerine direne olurlar. Bir Journal of Turgut Özal Medical Center 4(1):

9 Böbreküstü bezleri E. Özbek NÕVÕP DUWHU LVH NRUWHNVL GLUHNW RODUDN JHoLS PHGXOOD\D HULúLU DUWHULD SHUIRUDQWHV PHGXOODU DUWHU YH PHGXOODQÕQ SDUDQNLPDO K FUHOHULQL NXúDWDQ NDSLOOHUOHUL YHUPHN ]HUH GDOODQÕU % \OHFH PHGXOODQÕQ GDPDU \DWD ÕQD NRUWLNDO VLQ ]RLGOHUGHQ venöz nitelikte, medullar arterlerden ise arteriyal QLWHOLNWH NDQ ERúDOÕU 0HGXOODQÕQ NDSLOOHUOHUL N o N kollektör venlere, onlar da santral vene direne ROXUODU 2UJDQÕ KLOXVXQGDQ WHUNHGHQ YHQH VXSUDUHQDO YHQ DGÕ YHULOLU (6,10,11,14,15,19-21). 2UJDQÕQ YDVN ODUL]DV\RQX IL]\RORMLN DoÕGDQ orn QHPOLGLU 0HGXOODQÕQ GDPDU \DWD ÕQD ERúDODQ NRUWHNVLQ NDSLOOHU NDQÕQGDNL VWHURLG KRUPRQODU kromafin hücrelerdeki feniletanolamin-n-metil transferaz (PNMT) enzimini indükleyerek adrenalin sentezi üzerinde etkili olabilirler (10,14,15). 0HGXOOD NDSLOOHUOHULQL VÕQÕUOD\DQ K FUHOHU WLSLN HQGRWHO\XPGXU.RUWHNVLQ VLQ ]RLGOHULQL VÕQÕUOD\DQ hücreler ise lityum karmin, tripan mavisi gibi vital ER\DODUÕ WXWDUODU %X ER\DODU HQGRWHO K FUHOHULQLQ \ ]H\LQH \DSÕúÕ\RU RODELOHFHNOHUL JLEL HQGRWHO\XP LOH SDUDQNLP K FUHOHUL DUDVÕQGD \HUOHúPLú PDNURIDMODU WDUDIÕQGDQ GD WXWXOX\RU RODELOLU $QFDN elektronmikroskopik olarak sinüzoid endotel hücrelerinin fagositoz yapabildikleri J VWHULOHPHPLúWLU (6,8,10,21,45,48-50). 2UJDQÕQ OHQIDWLN GDPDUODUÕ LVH VDGHFH NDSV ODGD NRUWLNDO WUDEHN ODODUGD YH JHQLú YHQOHUL ohyuhoh\hq ED GRNXVX LoLQGH EXOXQXU (6,10,14,15). Pleksus çöliakustan ve splanknik sinirden gelen PL\HOLQVL] YH PL\HOLQOL OLIOHU EH]LQ NDSV ODVÕQGD ELUNDo VHPSDWLN JDQJOLRQ K FUHVL GH LoHUHQ VÕN ELU VLQLU SOHNVXVX ROXúWXUXUODU %LUNDo OLI vazodilatasyon ve vazokonstrüksiyonu ayarlamak ]HUH NRUWHNVWHNL NDQ GDPDUODUÕQGD VRQODQÕUNHQ OLIOHULQ E \ N or XQOX X NRUWHNVL GLUHNW JHoHUHN SUHJDQJOLRQLN OLIOHU JLEL PHGXOODQÕQ SDUDQNLP K FUHOHULQGH VRQODQÕUODU YH VLQLU WHUPLQDOOHUL EX hücrelerle tipik sinapslar yaparlar. Splanknik sinir stimülasyonu, kromafin hücrelerden epinefrin ERúDOPDVÕQD QHGHQ ROXU VLQLU NHVLVL LVH PHGXOOD K FUHOHULQLQ VDOJÕODPD DNWLYLWHVLQL LQKLEH HGHU (5-15,19-21). KAYNAKLAR 1. Guyton AC. Human Physiology and Mechanisms of Disease, Fourth Edition, W.B. Saunders Company, Philadelphia / London / Toronto / Mexico City / Rio de Janeiro / Sydney / Tokyo / Hong Kong 1987; HQWHú * (UV ] % +DUSHUÕQ %L\RNLP\DVÕ %DUÕú.LWDEHYL øvwdqexo 3. 0HQWHú 1. +DUULVRQ øo +DVWDOÕNODUÕQGD 7HPHO %LOJLOHU &LOW,,, 0HQWHú.LWDEHYL 4. Bilge M. Fizyolojide Hormonlar Bilgisi, Güven Kitabevi, Ankara 1979; Liddle GW, Melmon KL. The Adrenals. In: Williams, R.H., Textbook of Endocrinology, Fifth Edition, W.B. Saunders Company, Philadelphia / London / Toronto 1974; Arey LB. Human Histology A Textbook in Outline Form, Fourth Edition, W.B. Saunders Company, Philadelphia / London / Toronto 1974; &ODUD 0 0DVNDU h +LVWRORML øvwdqexo hqly 7ÕS )DN <D\ÕQODUÕ 6HUPHW 0DWEDDVÕ 8. (UEHQJL 7 +LVWRORML ønlqfl %DVNÕ * QHú.LWDEHYL $QNDUD 1990; (UNRoDN $ g]ho +LVWRORML ' UG QF %DVNÕ $QNDUD hqly 7ÕS )DN %DVÕPHYL 10. Fawcett DW. Bloom and Fawcett A Textbook of Histology, Eleventh Edition, W.B. Saunders Company, Philadelphia / London / Toronto / Mexico City / Rio de Janeiro / Sydney / Tokyo / Hong Kong 1986; Junqueira LC, Carneiro J, Kelley RO. Basic Histology, Seventh Edition, Apleton & Lange 1992; DOD\FÕ ù +LVWRORML 8OXGD hqly %DVÕPHYL 13. Kelly DE, Wood RL, Enders AC. Bailey's Textbook of Microscopic Anatomy, Eighteenth Edition, Williams & Wilkins, Baltimore / London 1984; Leeson TS, Leeson CR, Paparo AA. Text / Atlas of Histology, W.B. Saunders Company, Philadelphia / London / Toronto / Montreal / Sydney / Tokyo 1988; Ross MH, Reith EJ, Romrell LJ. Histology A Text and Atlas; Second Edition; Williams & Wilkins; Baltimore / Hong Kong / London / Munich / San Francisco / Sydney / Tokyo 1989; D\DOÕ + ùdwõur OX * 7Dú\ UHNOL 0 øqvdq (PEUL\RORMLVL $OWÕQFÕ %DVNÕ (YULP %DVÕP <D\ÕP 'D ÕWÕP øvwdqexo 1989; HWRUDN ø 0HGLNDO (PEUL\RORML ønlqfl %DVNÕ %HWD %DVÕP <D\ÕP 'D ÕWÕP øvwdqexo 18. Sadler TW. Lagman's Medical Embryology, Sixth Edition, Williams & Wilkins, Baltimore / Hong Kong / London / Munich / Philadelphia / Sydney / Tokyo 1990; dlphq $ $QDWRPL ønlqfl %DVNÕ 8OXGD hqly %DVÕPHYL 1991; GDU ø9 $QDWRPL 'HUV.LWDEÕ ønlqfl &LOW 2QELULQFL %DVNÕ (OLI 0DWEDDFÕOÕN $.RPDQGLW ùlunhwl 21. 8OXWDú ø $QDWRPL 'HUV.LWDEÕ 'RODúÕP 6LVWHPL YH øo 6DOJÕ %H]OHULQLQ $QDWRPLVL ' UG QF %DVNÕ 5HINR ø]plu 1984; Greiner JW, Kramer RE, Colby HD. Changes in Adrenocortical Function in Male and Female Guinea-Pigs During Maturation. J Endocr 1976;70: Martin KO, Black VH. d 4 -Hydrogenase in Guinea Pig Adrenal: Evidence of Localization in Zona Reticularis and Age-Related Change. Endocrinology 1982;110(5): Rebuffat P, Belloni AS, Rocco S, et al. The Effects of Ageing on the Morphology and Function of the Zonae 142

10 Özbek E. Fasciculata and Reticularis of the Rat Adrenal Cortex. Cell Tissue Res 1992; 270 (2): Majchrzak M, Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XII. Stereologic Studies of Rat Adrenal Cortex in the Course of Maturation. Cell Tissue Res 1983; 232: Nikicicz H, Kasprzak A, Majchrzak M, Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XVII. Analysis of Adrenal Growth Rate in Maturing Male and Female Rats and Hamsters. Gegenbaurs Morph Jahrb Leipzig 1984;130 (4): Kasprzak A, Lesniewska B, Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XXI. The Effects of Gonadectomy and Testosterone or Estradiol Replacement on Mitotic Activity of the Rat Adrenal Cortex. Exp Clin Endocrinol 1986;87 (1): Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XXIV. Comparative Morphometric Studies on Adrenal Cortex of Intact Mature Male and Female Rats of Differet Strains. Cell Tissue Res 1987; 249: Malendowicz LK, Stachowiak A, Zabel M. Sex Differences in Adrenocortical Structure and Function. XXV. Quantitative Analysis of ACTH-Immunoreactive Cells in the Anterior Pituitary of Gonadectomized and Gonadal Hormone Replaced Male and Female Rats. Exp Clin Endocrinol 1987;90 (1): Malendowicz LK, Robba C, Nussdorfer GG. Sex Differences in Adrenocortical Structure and Function XXII. Light- and Electron-microscopic Morphometric Studies on the Effects of Gonadectomy and Gonadal Hormone Replacement on the Rat Adrenal Cortex. Cell Tissue Res 1986;244: Trzeciak WH, Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. VII. Adrenal Sterol Ester Hydrolase Activity in the Rat and Its Dependence on Gonadal Hormones. Horm Metab Res 1981;13(9): Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. V. The Effects of Postpubertal Gonadectomy and Gonadal Hormone Replacement on Nuclear-cytoplasmic Ratio, Morphology and Histochemistry of Rat Adrenal Cortex. Folia Histochem Cytochem (Krakow) 1979;17(3): Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XVI. Stereological and Karyometric Studies on the Cortex of the Suprarenal Gland of Intact Adult Male and Female Mongolian Gerbils (Meriones Unguiculatus). J Anat 1984;139(3): Nikicicz H, Kasprzak A, Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XIII. Stereologic Studies on Adrenal Cortex of Maturing Male and Female Hamsters. Cell Tissue Res 1984;235: Mazzocchi G, Malendowicz LK, Robba C, et al. Effects of Testosterone on the Zona Fasciculata of the Male Rat Adrenal Cortex. A Correlated Stereological and Biochemical Study. J Submicrosc Cytol 1983; 15 (4): Lesniewska B, Nowak M, Malendowicz LK. Sex Differences in Adrenocortical Structure and Function. XXVIII. 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