Medical Articles

The Adrenal Gland

Anatomy

  • Right
  • Left
  • Micro anatomy
    • Cortex
      • Glomerulosa
      • Fasciculata
      • reticularis
    • Medulla

Physiology

  • Aldosterone
  • Cortisol
  • Sex hormones
  • Adrenaline
  • Noradrenaline

Aldosterinoma – Conn's Syndrome

  • Triad
    • HPT
    • Hypokalemia (Hyponatraemia and chloraemia)
    • Poliuria
  • PAC:PRA
  • 2//3 aldosteronoma and 1/3 hyperplasia
  • Allways benign

Adrenal Cushings

  • ACTH dependant
    • 80% central
    • 20% paraneoplastic
  • ACTH Independent
    • Adenoma
    • Carcinoma
    • Micro and macronodular hypertrophy
  • Corttiisol replacement

Virilizing and feminising tumours

  • 80% Malignant
  • Testosterone, DHEAS,, 17 ketosteroids
  • Dexamethasone supression = ovarian

Adrenal cortical carcinoma

  • ACC presentation

Incidentaloma

  • Discovered per chance (4%)
  • Indications for resection
    • Function
    • Rapid growth
    • Size
    • Imaging characteristics

Pheochromocytoma

  • Adrenal medulla and paraganglia
  • 10% tumour
  • 25% RET (MEN2), VHL, NF Type II
  • Biochemistry:
    • Urinary metanephrines
    • Fractionated metanephrines

Preop - Pheo

  • Alpha block
    • Doxazocin, Phenoxybenzamine