SU23.1-2 | Adrenal Anatomy and Adrenal Disorders — Summary & Reflection

KEY TAKEAWAYS

The adrenal is two glands in one: a cortex (zona glomerulosa→aldosterone, zona fasciculata→cortisol, zona reticularis→androgens — 'salt, sugar, sex') and a medulla whose chromaffin cells make catecholamines. Surgically, the gland is retroperitoneal with a rich threefold arterial supply and an asymmetric venous drainage — the short right adrenal vein drains directly into the IVC (hazardous), the longer left into the left renal vein. The functional disorders map onto the histology: Cushing's syndrome (cortisol — moon face, striae, bruising, diabetes), Conn's syndrome (aldosterone — hypertension + hypokalaemia), phaeochromocytoma (catecholamines — episodic headache, sweating, palpitations; rule of 10s), and adrenocortical carcinoma (large irregular cortical malignancy). The work-up rule is to confirm the hormonal syndrome biochemically FIRST (dexamethasone suppression; aldosterone:renin ratio; metanephrines) and localise second (adrenal-protocol CT/MRI ± functional imaging). Treatment is usually laparoscopic adrenalectomy, with two non-negotiables: alpha-blockade before beta-blockade in phaeochromocytoma, and perioperative steroid cover for cortisol-related and bilateral surgery.

REFLECT

Think back to a patient you have seen with difficult-to-control hypertension, or imagine clerking one. Did the possibility of a secondary, surgically curable cause — Conn's syndrome or phaeochromocytoma — cross your mind, and would you have known which screening test to send first? Now consider the discipline of confirming the biochemical syndrome before chasing an image: how would you explain to a patient with an incidentally discovered adrenal mass why they need blood and urine tests before anyone talks about an operation? Finally, reflect on the alpha-before-beta rule in phaeochromocytoma — a single piece of sequencing that can be the difference between a safe anaesthetic and a hypertensive catastrophe — and on how understanding the gland's anatomy and physiology turns each of these decisions from a memorised fact into reasoning you can defend.