The adrenal (suprarenal) glands are two small glands sitting on top of the kidneys, the right one roughly pyramidal and the left more crescent-shaped. Each is really two glands in one: an outer cortex that makes steroid hormones such as cortisol and aldosterone, and an inner medulla that releases adrenaline and noradrenaline.
| Location | Retroperitoneal, on the superomedial pole of each kidney within the renal fascia, at about T12; the right behind the IVC, the left near the aorta and behind the stomach and pancreas |
|---|---|
| Secretes |
|
| Nerve Supply | Preganglionic sympathetic fibres from the thoracic splanchnic nerves (to the medulla) |
| Blood Supply | Superior suprarenal arteries (from the inferior phrenic artery); Middle suprarenal artery (from the aorta); Inferior suprarenal artery (from the renal artery) |
| Venous drainage |
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| Lymphatic drainage |
|
The cortex controls salt and water balance, the stress and metabolic response and some androgen production; the medulla releases catecholamines for the fight or flight response.
The right adrenal vein is very short and drains straight into the inferior vena cava, which makes right adrenalectomy technically demanding. Adrenal 'incidentalomas' are common findings on CT and need testing for hormone excess and assessment of cancer risk. Adrenal crisis from cortisol deficiency is life threatening and requires immediate hydrocortisone.
Primary adrenal insufficiency, usually autoimmune, causing fatigue, weight loss, low blood pressure, skin darkening and risk of adrenal crisis.
Prolonged excess cortisol from steroid medication, an adrenal tumour or excess ACTH, causing central weight gain, thin skin, muscle weakness and diabetes.
An adrenal mass found by chance on imaging, most often a harmless non-functioning adenoma.
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