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ANATOMY OF ADRENAL GLAND

Dr.Udhayabharathi.G Dept of Anatomy GMKMC SALEM

History
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Claudius Galen - accessory renal tissue. "loose flesh . The first anatomist to give a detailed description of the human adrenal glands, was Bartholomeus Eustachius (1520- 1574) In his publication of 1563.

Thomas Addison presented a paper on the clinical features of patients with adrenal disease. In 1856, Charles Brown-Squard provided experimental proof of the vital role of the adrenals by performing adrenalectomies (removing the adrenals) from several species of animals. Sir William Osler found that symptoms of adrenal insufficiency (Addison's disease) could be temporarily improved by an adrenal extract

Introduction
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Among most important and vital endocrine organ

Small bilateral yellowish retroperitoneal organ

Lies just above kidney in gerotas fascia

Anatomy
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Right adrenal is triangular, related to upper pole Right kidney Left adrenal is crescent shaped, related to upper and medial part Left kidney Size : Weight : 50x30x10 mm 5 gm app

Anatomy
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Embryology
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Cortex is mesodermal in origin Week 4 6 : start from coelomic mesoderm adjacent to urogenital ridge Week 8 : differentiate into thin definite outer cortex and thick inner fetal cortex

Embryology
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Cont:
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Fetal cortex produce steroid during gestation and involutes at birth Definite cortex develop into functional adrenal cortex

Embryology
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Medulla derived from neural crest cells Develop with sympathetic nervous system

Week 5 : neural crest cell migrate to Para-aortic and Para-vertebral region towards medial aspect of adrenal cortex

Cont:
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Extra adrenal chromaffin cells located to the left of aortic bifurcation near the origin of IMA

Embryology
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Embryology
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Embryology
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Relations
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RT ADRENAL Anteriorly IVC Liver

LT ADRENAL Anteriorly Pancreas Stomach

Posteriorly Diaphragm

Posteriorly Diaphragm

Relations
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Histology
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Adrenal cortex consists of three distinct zones Zona Glomerulosa : Small cells arranged into small rounded groups Zona Fasiculata : cell cords arranged radially arranged cell cords separated by fenestrated sinusoid capillaries.cell cytoplasm is also light and often "foamy" or "spongy" appearance (due to lipid droplets)

Cont :
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Zona Reticularis : small cells with large nucleus, and eosinophilic cytoplasm and arranged as anastomosing cords. (lipofucsin accumulates with age, orange colour in H&E). Zona glomerulosa and fasiculata present at birth Zona reticularis develops during first year of life

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Histology
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Physiology
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Adrenal gland has two distinct zones Adrenal cortex Adrenal medulla

Physiology
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Adrenal cortex produces -Mineralocorticoids (Zona Glomerulosa) -Glucocorticoids (Zona Fasciculata)

-Adrenal androgens (Zona Reticularis)

Physiology
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Adrenal medulla produces -Epinephrine (adrenaline) -Norepinehrine (noradrenaline) Help inc in cardiac output, vascular resistance and mediate stress response All are absolutely required for life

Functions
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Aldosterone helps in Na reabsorption & potassium excretion & preventing dehydration Cortisol stimulate protein breakdown, inhibition of tissue response in injury & antagonism to action of insulin Androgens helps in early development of male sex organ in childhood

Functions
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Vascular supply
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Blood to adrenal supplied by Inferior phrenic artery (superiorly) Aorta (medially) Renal artery (inferiorly)

Vascular supply
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Right Adrenal

: drained to IVC via adrenal vein : drained into left adrenal vein or directly to IVC : drained to Para-aortic and para-caval lymph nodes

Left Adrenal

Lymphatics

Vascular supply
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Vascular supply
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APPLIED ASPECT
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Congenital adrenal hyperplasia Pheochromocytoma Adenoma/carcinoma Acute/chronic adrenal insufficiency(Addisons disease) Cushings disease/syndrome.

Addisons disease
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Cushings syndrome
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Adrenal Adenoma
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Adrenal Carcinoma
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Normal Adrenal On MRI

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