ADRENAL / SUPRARENAL GLANDS

Dr.B. Veeresalingam
M.S.,F.I.C.S.,M.A.M.S.(AUS).,F.A.I.S.
Professor of Surgery.
 ADRENAL / SUPRARENAL GLANDS
ANATOMY :
 2 suprarenal glands resting on the superior
anterior and medial aspects of upper pole of
corresponding kidney.
 The right one shaped like a top hat and left one
is shaped like a cocked hat.
 Each one is 30-50 mm in height and
30mm in width.
 Right one is at higher level than left -
reverse of kidney position.
Art. supply : 3 arteries to each adrenal 1) superior ad.
from inferior phrenic art. 2) Middle adrenal art
from aorta 3) Inferior adrenal from renal artery.
Veinous drianage :
Only one vein drains each gland
Rt drains into I.v cava;
Lt drians into L.Renal vein.
Lymphatic drianage : Para aortic L.nodes.
PHYSIOLOGY :
- Adrenal has got cortex and medulla.
- cortex develops from mesoderm, Medulla
from Neuroectoderm or neural crest cells.
- Even though anatomically cortex and
medulla are related physiologically separate
in their internal secretions.
 ADRENAL CORTEX
A.C is made up of 3 layers from without inwards :
1) zona glomarulosa. 2)zona Fasciculata 3) zona reticularis.
- 50 steroid hormones isolated from cortex.
They are 3 groups:
I. MINERELOCORTICOIDS : Maintenance of water and
electrolyte balance.
- ALDOSTERONE is important of these salt regulating
hormones.
II. GLUCOCORTICOIDS : Concerned with protein and
carbohydrate metabolism.
- Hydrocortisone (cortisol) and cortisone are the hormones.
III. SEX HORMONES : ANDROGENIC AND OESTROGENIC
hormones.
INTER HARMONIC ACTION: Ant pituitary secretes ACTH
which stimulates adrenal cortical secretion. Level of
cortisol controls ACTH secretion (like TSH &
thyroxine).
- ACTH production also controlled by Hypothalamic
corticotrophin releasing hormone (like T.R.H).
DISEASES OF ADRENAL CORTEX :
HYPOCORTICISM : Chronic adrenocortical insufficiency
due to progressive destruction of all the layers of
cortex & medulla- ADDISION’S DISEASE.
60% autoimmune diseases;
40% TB, metastatic ca; amyloidosis.
ADDISION’S DISEASE : Muscular weakness, low BP,
Pigmentation of skin and Mucous membrane.
TRT: Medical long term management with
Hydrocortisone 20-30mg in divided doses.
HYPERCORTICISM :- Due to bilateral hyperplasia, a
benign adenoma or a malignant carcinoma.
Thus in the lesion of cortex:
1. EXCESS OF ALDOSTERONE causes :
ALDOSTERONISM which leads to Na retention and a
fall in serum potassium resulting in HYPERTENSION.
2. EXCESS OF CORTISOL causes :
CUSHING’S SYNDROME : which leads to deposition
of fat in certain situations. Face is round like a full
moon, abdomen protruberant, thick neck, supra
clavicular fossa obliterated, fat appears over the
region of vertebrae - buffalo hump.
- legs are relatively thin. Hypertension is frequent.
3. EXCESS of ANDROGENS causes :
ADRENOGENITAL SYNDROME
which leads to Amenorrhea ,oligomenorrhea ; excess
hair growth over face, atrophy of breast; alteration
of voice.
4. EXCESS of OESTROGEN causes : FEMINISATION IN
MALES.
INVESTIGATIONS CONCERNED WITH ADRENAL
CORTICAL ACTIVITY :
1. PLASMA ELECTROLYTES : Na and K.
2. PLASMA CORTISOL LEVELS.
3. PLASMA ACTH ESTIMATION.
4. PLASMA ALDOSTERONE LEVELS.
5. Urinary excretion of cortisol estimation in 24
hours is useful in adrenocortical over
secretion.
6. Urinary excretion of 17 oxosteroids or
ketosteroids estimation reflects ANDROGEN
output.
Excretion is increased in Adrenogenital
syndrome in females.
7. Radiology : C.T.Scan
8. M.R.I
 ADRENAL MEDULLA
they are connected anatomically & physiologically with
splanchnic nerves .
PHYSIOLOGY :
They secrete CATECHOLAMINES – ADRENALINE and
NORADRENALINE (in maintaining B.P)
DISEASES OF AD.MEDULLA :
PHAEOCHROMOCYTOMA : a benign tumor.
BENIGN GANGLIONEUROMA
MALIGNANT NEURO BLASTOMA
PHAEOCHROMOCYTOMA : Is called as 10% tumor :
10% are bilateral; 10% are malignant; 10% extra
adrenal, 10% multiple; 10% familial; 10% occur in
children.
Symptoms : paroxysmal or persistent
Hypertension due to excess Secretion of
adrenaline or noradrenaline.
M.E.N.Syndrome : Multiple endocrine neoplasia
syndrome: Medullary ca thyroid; parathyroid
tumor; Adrenal phaeochromocytoma.
TREATMENT : Adrenal Hyperplasia or tumors :
surgery.
LAPAROSCOPIC ADRENALECTOMY.