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Introduction
1. Anatomy
1.1 Immune system, blood and lymphoreticular system
1.2 Nervous system and special senses
1.3 Skin and subcutaneous tissue
1.4 Musculoskeletal system
1.5 Anatomy of the cardiovascular system
1.6 Respiratory system
1.7 Respiratory system additional information
1.8 Renal and urinary system
1.9 Renal system additional information
1.10 Gastrointestinal system
1.11 Gastrointestinal system additional information
1.12 Duodenum
1.13 Liver
1.14 Female reproductive system and breast
1.15 Female reproductive system additional information
1.16 Fallopian tubes
1.17 Male reproductive system
1.18 Male reproductive system additional information
1.19 Prostate
1.20 Endocrine system
1.20.1 Thyroid and parathyroid glands
1.20.2 Adrenal glands
1.20.3 Pancreas
1.20.4 Adipose tissue
1.21 Embryology
1.22 Additional information
2. Microbiology
3. Physiology
4. Pathology
5. Pharmacology
6. Immunology
7. Biochemistry
8. Cell and molecular biology
9. Biostatistics and epidemiology
10. Genetics
11. Behavioral science
Wrapping up
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1.20.4 Adipose tissue
Achievable USMLE/1
1. Anatomy
1.20. Endocrine system

Adipose tissue

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Adipose tissue is a dynamic tissue and is considered the largest endocrine organ in the human body. It has two types - brown and white adipose tissue - which differ in both anatomy and function.

White adipose tissue is the predominant type in adults. Brown adipose tissue is seen mostly in newborns and is also present behind the kidneys in adults.

White adipose tissue is made up of adipocytes (fat cells) that are:

  • Large and unilocular (they contain a single fat droplet in the cytoplasm)
  • Characterized by a flat, peripherally placed nucleus
  • Relatively low in mitochondria

White adipose tissue appears yellow due to the presence of carotene. It is distributed in:

  • Subcutaneous tissue
  • The abdominal cavity (in peritoneal folds)
  • The mediastinum
  • Between muscles
  • Bone marrow
  • Around visceral organs such as the kidneys

In contrast, brown adipocytes are:

  • Smaller and multilocular (they contain multiple fat droplets in the cytoplasm)
  • Rich in mitochondria
  • Characterized by a centrally placed nucleus

Brown fat is specialized for thermogenesis (heat production), helping to keep the body warm. It participates in non-shivering thermogenesis through oxidation of fatty acids and the action of uncoupling protein (UCP 1). The brown color comes from rich circulation and the high number of mitochondria containing heme-containing cytochrome c.

Apart from adipocytes, adipose tissue also contains a stroma made up of blood vessels, pericytes, and precursor cells called pre-adipocytes. When excess fat needs to be stored:

  • Existing adipocytes undergo hypertrophy
  • Pre-adipocytes differentiate into adipocytes

White adipose tissue plays a key role in everyday metabolism by secreting many hormones, growth factors, and cytokines with endocrine, paracrine, and autocrine functions. After menopause, androstenedione secreted by the adrenal gland is converted into oestrone in adipose tissue. Oestrone is then eventually converted to oestradiol in peripheral tissues.

Important molecules secreted by adipose tissue and their effects on the body

Secretion Effect on the body
Leptin Role in the regulation of appetite, satiety, hunger, food intake and body weight
Adiponectin Protective role in the pathogenesis of obesity, insulin resistance, Diabetes Mellitus and cardiovascular disease. Anti Inflammatory molecule
TNF alpha Pro-inflammatory cytokine, linked to the development of insulin resistance and metabolic syndrome, among other effects
IL 6 Cytokine with important role in inflammation, obesity and glucose metabolism
Angiotensinogen Precursor molecule of Angiotensin II, regulation of blood pressure, fluid and electrolyte metabolism
Free fatty acids Used for energy production and synthesis of triglycerides
Glycerol Precursor to many structural lipids, gluconeogenesis
PAI 1 (plasminogen activator inhibitor) Prothrombotic, inhibits the activation of plasminogen
Vascular endothelial growth factor (VEGF) Angiogenesis
ASP (acylation stimulating protein) Regulates rate of TG synthesis in adipose tissue
Adipsin Serine protease, activates the alternative pathway of complement; postulated that deficiency may lead to obesity
IGF 1 (insulin like growth factor) Anabolic role, mediates the effects of growth hormone
Resistin Cysteine rich peptide hormone, expressed in macrophages, proinflammatory, involved in the pathogenesis of atherosclerosis, obesity and cardiovascular disease

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