Adrenal - TheAdrenal VicVernenkar,D.O. St.Barnabas...

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    The Adrenal Vic Vernenkar, D.O. St. Barnabas Dept. Of Surgery
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Adrenal Anatomy Composed of a  cortex  and  medulla which have separate embryology.
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Adrenal Anatomy The adrenal cortex  arises fro m the  coelomic mesoderm between the fourth  and sixth weeks of gestation.
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Adrenal Anatomy  The adrenal medulla  is derived from cells of  the  neural crest  that also form the  sympathetic nervous system and the  sympathetic ganglia.Some of these neural  crest cells migrate into the adrenal cortex to  form the adrenal medulla, but chromaffin  tissue may also develop in extraadrenal sites. The most common  site of extraadrenal  chromaffin tissue is the  organ of Zuckerkandl located adjacent to the aorta near IMA.
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Adrenal Anatomy The glands weigh about 4g each,  located in the retroperitoneum along the  superior-medial aspect of the kidneys. Yellow appearance because of their  high lipid content. 3-5 cm in length, 4-6mm in thickness
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Adrenal Glands (Normal)
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Adrenal Anatomy Left>right Receive arterial blood from branches of the  inferior  phrenic  artery,  aorta , and  renal   arteries. The right adrenal vein  is short and exits the  gland medially to enter the  vena cava . The  left adrenal vein  exits anteriorly and usually  drains into the  left renal vein . As a result,  adrenal venous catheterization is  accomplished more easily on the left than the  right.
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Adrenal Anatomy The adrenal cortex is composed of  three zones  histologically. Outer zona  glomerulosa , site for  aldosterone  synthesis. Central zona  fasciculata  and inner  zona  reticularis  produce both  cortisol   and  androgens .
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Adrenal Anatomy Most of the blood supply to the medulla  comes from venous blood draining  through the cortex. This provides the  adrenal chromaffin cells with high  concentration of the enzyme  phenyethanolamine N-  methyltransferase (PNMT) required for  conversion of norepinephrine to  epinephrine.
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The Cortex Three major hormones Cortisol Androgens Aldosterone
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The Cortex Zona glomerulosa  is the  exclusive site   of production of  aldosterone  because it  lacks the enzyme 17 alpha hydroxylase   necessary for production of 17 a-  progesterone  and 17 a-pregnalone which are the precursors to cortisol and  androgens.
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The Cortex Zona fasciculata  and  reticularis   function as a unit to produce  cortisol androgens , and small amounts of  estrogen , but it lacks the enzymes  necessary to convert 18- hydroxycorticosterone to aldosterone.
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Cortex Cholesterol is the precursor  from which  all adrenal steroids are synthesized. Conversion of cholesterol to 
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Adrenal - TheAdrenal VicVernenkar,D.O. St.Barnabas...

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