Selective neural regulation of epinephrine and norepinephrine cells in the adrenal medulla-cardiovascular implications

The innervation of the adrenal medulla regulates the release of catecholamines from the two, epinephrine (EPI) and norepinephrine (NE), populations of chromaffin cells. Adjustments in the neural output to the adrenal medulla are made by centers in the brain that integrate the sensory input arising from a variety of challenges and the resulting changes in secretion assist in the restoration of homeostasis. Interestingly, the adrenal medullary secretory responses do not simply reflect increments a fixed ratio of EPI to NE as might be expected if release was proportional to the number EPI and NE cells. Instead, the ratio of EPI to NE changes depending on the magnitude and type of stimulus that initiates neural activation of the medulla. The variability in the EPI:NE release ratio implies that the EPI and NE cells can be differentially stimulated. Although the underlying mechanisms are not fully characterized, this review presents an emerging view that the selective control of EPI and NE cells is accounted for, first, by the existence of separate neural circuits between brain centers and the chromaffin cells, and second, through neuromodulation that selectively influences EPI and NE cells. The presence of mechanisms that allow for separate control of the EPI and NE cells may significantly augment the range of cardiovascular and metabolic responses mediated through activation of the adrenal medulla.