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What is driving your Stress Levels? Anatomically Speaking. The anatomy of the Inconspicuous Adrenal gland.

Introduction:

Paired endocrine organ which sits above the kidney.

Important in synthesis of cortisol, adrenaline, nor-adrenaline.

  • Part of the endocirne and neurological systems

  • Essentially different organs within the same structure composed of a thick outer cortex and thin inner medulla.

  • Lie within the PERIRENAL SPACE bilaterally

  • BOUNDed by the PERIRENAL fascia, above and medial to the kidneys

  • Composed of a body and 2 limbs.

 

Gross anatomy:

Outer cortex:

  • Embryologically derived from the mesoderm

  • Divided into 3 distinct zones

    • Zona glomerulosa  (mineralocorticoids - aldosterone)

    • Zona fasciculata (Glucocorticoids - cortisole)

    • Zona reticularis (Androgens)

Inner Medulla:

  • Embryologically derived from the neural crest

  • Part of the sympathetic nervous system

  • Chromaffin cells secreted catecholamines (epinephrine) into blood stream.

 

Relations:

  • The right adrenal

    •  is usually more apical in location

    • LIES ANTERIORLATER TO THE RIGHT CRUS of the diaphragm, medial to liver and posterior to the IVC

    • Often pyramidal in shape with an inverted V shape on transverse section.

  • Left

    • Usually more caudal and lies media to the upper pole of the left kidney, lateral to the left crux of the diaphragm, and posterior to the splenic vein and pancreas.

    • Often crescentic in shape with a  triangular cross-section.

 

INFERIOR: superior pole of the kidney

SUPERIOR: Diaphragm

Medial: psoas, aorta on the left, IVC on the right

POSTERIOR: Quadratus lumborum

Lateral: liver on the right, Spleen on the left.

Anterior: lesser sac, duodenum.

 

Arterial supply:

Superior adrenal arteries: from inferior phrenic arteries

Middle adrenal artery: from the aorta at the Lv of L1.

Inferior adrenal artery: from the renal artery

 

Venous drainage:

  • Right adrenal vein drains into the IVC

  • Left adrenal vein drains into the left renal vein

Lymphatics

  • Para aortic and para caval lymphnodes

 

Nerve supply

  • Sympathetic: Extensive connection to the adrenal medulla.

  • Presynaptic sympathetic fibres from the paravertebral ganglia end directly on secretory cells of the medulla.

 

Variants:

  • Pancake adrenal gland

  • ectopic adrenal gland - ie accessory adrenal rests, often near adreanl glands but may be found any where in abdo, pelvis, or scrotum.

  • Hypoplasia/Agenesis

 

Images from Stat Dx: 

Image from Stat Dx: https://my.statdx.com/document/adrenal/8b668baa-0efb-4063-9904-6671e87cb86b?searchTerm=adrenal%20gland

 

References:

  • https://radiopaedia.org/articles/adrenal-gland

  • Shirkhoda A. Variants and Pitfalls in Body Imaging. LWW. ISBN:0781797888. Read it at Google Books - Find it at Amazon

  • https://my.statdx.com/document/adrenal/8b668baa-0efb-4063-9904-6671e87cb86b?searchTerm=adrenal%20gland

  • McMINN. Lasts Anatomy Regional and Applied. CHURCHILL LIVINGSTONE. (2003) ISBN:B0084AQDG8. Read it at Google Books - Find it at Amazon

     

     

     

     

     

     

     

     

     

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