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Anatomy of the suprarenal glands
Endocrine
Anatomy of the suprarenal glands
Kidneys and suprarenal glands The left suprarenal gland is said to look like a workman’s cap, while the right is the shape of a top hat. Note especially the short right and long left suprarenal vein Aorta
Harold Ellis
Inferior vena cava Right suprarenal vein
Left suprarenal vein
Abstract This contribution discusses the basic anatomy of the suprarenal glands.
Keywords suprarenal; kidneys; cortex; medulla; mesoderm
Gonadal veins Figure 1
The suprarenal glands cap the upper poles of the kidneys and lie against the corresponding crus of the diaphragm. The typical appearance on CT is of an ‘arrowhead’ lying against the easily identified crus on each side. The left is related anteriorly to the stomach across the lesser sac; the right lies behind the right lobe of the liver and tucks medially behind the inferior vena cava (Figure 1). Each gland weighs only 3–4 g and is supplied by three arteries: • a direct branch from the aorta • a branch from the phrenic artery • a branch from the renal artery. The single main vein drains from the hilum of the gland into the nearest available vessel, which is the inferior vena cava on the right or the renal vein on the left. The stubby right suprarenal vein,
coming directly from the inferior vena cava, presents the most dangerous feature in carrying out an adrenalectomy—the trainee surgeon should choose the easier left side and leave the right to a more experienced colleague. The suprarenal gland comprises a cortex and medulla, which represent two developmentally and functionally independent endocrine glands in the same anatomical structure. The medulla is derived from the neural crest (ectoderm), cells from which also give rise to the sympathetic ganglia. The cortex is derived from the mesoderm. The suprarenal medulla receives preganglionic sympathetic fibres from the greater splanchnic nerve and secretes adrenaline and noradrenaline. The cortex secretes the adrenocortical hormones. ◆
Harold Ellis CBE FRCS FRCOG is Emeritus Professor of Surgery, University of London (Charing Cross and Westminster Medical School), London, UK. He is Clinical Anatomist in the Division of Anatomy at King’s College (Guy’s campus), London, UK. Conflicts of interest: none declared.
SURGERY 25:11
492
© 2007 Published by Elsevier Ltd.
Anatomy of the suprarenal glands
Kidneys and suprarenal glands The left suprarenal gland is said to look like a workman’s cap, while the right is the shape of a top hat. Note especially the short right and long left suprarenal vein Aorta
Harold Ellis
Inferior vena cava Right suprarenal vein
Left suprarenal vein
Abstract This contribution discusses the basic anatomy of the suprarenal glands.
Keywords suprarenal; kidneys; cortex; medulla; mesoderm
Gonadal veins Figure 1
The suprarenal glands cap the upper poles of the kidneys and lie against the corresponding crus of the diaphragm. The typical appearance on CT is of an ‘arrowhead’ lying against the easily identified crus on each side. The left is related anteriorly to the stomach across the lesser sac; the right lies behind the right lobe of the liver and tucks medially behind the inferior vena cava (Figure 1). Each gland weighs only 3–4 g and is supplied by three arteries: • a direct branch from the aorta • a branch from the phrenic artery • a branch from the renal artery. The single main vein drains from the hilum of the gland into the nearest available vessel, which is the inferior vena cava on the right or the renal vein on the left. The stubby right suprarenal vein,
coming directly from the inferior vena cava, presents the most dangerous feature in carrying out an adrenalectomy—the trainee surgeon should choose the easier left side and leave the right to a more experienced colleague. The suprarenal gland comprises a cortex and medulla, which represent two developmentally and functionally independent endocrine glands in the same anatomical structure. The medulla is derived from the neural crest (ectoderm), cells from which also give rise to the sympathetic ganglia. The cortex is derived from the mesoderm. The suprarenal medulla receives preganglionic sympathetic fibres from the greater splanchnic nerve and secretes adrenaline and noradrenaline. The cortex secretes the adrenocortical hormones. ◆
Harold Ellis CBE FRCS FRCOG is Emeritus Professor of Surgery, University of London (Charing Cross and Westminster Medical School), London, UK. He is Clinical Anatomist in the Division of Anatomy at King’s College (Guy’s campus), London, UK. Conflicts of interest: none declared.
SURGERY 25:11
492
© 2007 Published by Elsevier Ltd.