adrenal anatomy

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radiological anatomy of adrenal gland

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Anatomy of Adrenal Gland : 

1 Anatomy of Adrenal Gland By Dr Sohail Amin Resident-1

Introduction : 

2 Introduction Among most important and vital endocrine organ Small bilateral yellowish retroperitoneal organ Lies just above kidney in gerota’s fascia

Anatomy : 

3 Anatomy Right adrenal is triangular, related to upper pole Right kidney Left adrenal is crescent shaped, related to upper and medial part Left kidney Size : 3 - 6cm long, 0.9 – 3.6cm Weight : 3-5 gm app Width : 2-3 cm

Anatomy : 

4 Anatomy

Embryology : 

5 Cortex is mesodermal in origin Week 4 – 6 : start from coelomic mesoderm adjacent to urogenital ridge Week 8 : differentiate into thin definite outer cortex and thick inner fetal cortex Embryology

Cont: : 

6 Cont: Fetal cortex produce steroid during gestation and involutes at birth Definite cortex develop into functional adrenal cortex

Embryology : 

7 Embryology Medulla derived from neural crest cells Develop with sympathetic nervous system Week 5 : neural crest cell migrate to Para-aortic and Para-vertebral region towards medial aspect of adrenal cortex

Cont: : 

8 Cont: Extra adrenal chromaffin cells located to the left of aortic bifurcation near the origin of IMA

Embryology : 

9 Embryology

Embryology : 

10 Embryology

Embryology : 

11 Embryology

Embryology : 

12 Embryology

Histology : 

13 Histology Adrenal cortex consists of three distinct zones Zona Glomerulosa : small cells with intermediate no. of lipid inclusion Zona Fasiculata : large foamy cells sec to lipid inclusion -75% of cortex

Cont : : 

14 Cont : Zona Reticularis : consists of compact cytoplasm and few lipid inclusions Zona glomerulosa and fasiculata present at birth Zona reticularis develops during first year of life

Slide 15: 

15

Histology : 

16 Histology

Physiology : 

17 Physiology Adrenal gland has two distinct zones Adrenal cortex Adrenal medulla

Physiology : 

18 Physiology Adrenal cortex produces -Glucocorticoids (Zona Fasciculata) -Mineralocorticoids (Zona Glomerulosa) -Adrenal androgens (Zona Reticularis)

Physiology : 

19 Physiology Adrenal medulla produces -Epinephrine (adrenaline) -Norepinehrine (noradrenaline) Help inc in cardiac output, vascular resistance and mediate stress response All are absolutely required for life

Functions : 

20 Functions Aldosterone helps in Na reabsorption & potassium excretion & preventing dehydration Cortisol stimulate protein breakdown, inhibition of tissue response in injury & antagonism to action of insulin Androgens helps in early development of male sex organ in childhood

Functions : 

21 Functions

Slide 22: 

22

Relations : 

23 Relations RT ADRENAL Anteriorly IVC Liver Posteriorly Diaphragm LT ADRENAL Anteriorly Pancreas Stomach Posteriorly Diaphragm

Relations : 

24 Relations

Vascular supply : 

25 Vascular supply Blood to adrenal supplied by Inferior phrenic artery (superiorly) Aorta (medially) Renal artery (inferiorly) Rt adrenal : superior & inferior adrenal artery Lt adrenal : middle & inferior adrenal artery

Vascular supply : 

26 Vascular supply Right Adrenal : drained to IVC via adrenal vein Left Adrenal : drained into left adrenal vein or directly to IVC Lymphatics : drained to Para-aortic and para-caval lymph nodes

Vascular supply : 

27 Vascular supply

Vascular supply : 

28 Vascular supply

Imaging Modalities : 

29 Imaging Modalities Plain abdominal film Ultrasound (grey scale and Doppler) Adrenal venography Adrenal arteriography CT scan MRI Adrenal scintigraphy

Plain Abdominal Film : 

30 Plain Abdominal Film Plain abdominal film finding are non specific May be helpful in detecting Mass in adrenal area Calcification in adrenal

Slide 31: 

31

Ultrasound : 

32 Ultrasound Adult appearance Entirely hypoechoic Concave with straight margin Newborn Cortex hypoechoic, Medulla hyperechoic Cortex>>medulla thickness Convex border

Ultrasound : 

33 Ultrasound Investigation of first choice in infant , children and pregnant women Indication adrenal masses ( larger than 2 cm)

Ultrasound : 

34 Ultrasound

Ultrasound : 

35 Ultrasound

Ultrasound : 

36 Ultrasound

CT Scan : 

37 CT Scan On precontrast scan adrenal have soft tissue density similar to that of liver Normal adrenal appear inverted V or Y shape within retroperitoneal fat Consist of body , medial limb and lateral limb

Ct Scan : 

38 Ct Scan Thickness of each limb is 5 mm Maximum width of the body is 10-12mm Indication masses (adenoma & cancer) Cyst abscess metastasis

CT Scan : 

39 CT Scan

CT Scan : 

40 CT Scan

CT Scan : 

41 CT Scan Attenuation is measured in Hounsfield unit (HU) Benign masses have low attenuation values (< 20 HU ) Malignant masses have high attenuation values (> 20 HU )

CT Scan : 

42 CT Scan Unenhanced CT Scan Adenomas : < 10 HU Malignancies : > 20 HU Delayed enhanced CT Scan Adenoma : < 30 HU Malignancies : > 30 HU

Adrenal Adenoma : 

43 Adrenal Adenoma

Adrenal Adenoma : 

44 Adrenal Adenoma

Adrenal Carcinoma : 

45 Adrenal Carcinoma

MRI : 

46 MRI Equally effective as CT in imaging adrenal disorder Normal adrenal is intermediate signal intensity to liver and hypo intense to fat on TIW1 image On T2W2 image adrenal hypo intense to fat, iso intense to liver &hyper intense to crus

MRI : 

47 MRI Carcinoma have hyper-intense signal on T2W2 and hypointense on T1W1 images On contrast enhancement show rapid enhancement with sluggish washout Adenoma are hypointense, show mild enhancement & rapid contrast washout

Adrenal On MRI : 

48 Adrenal On MRI

Normal Adrenal On MRI : 

49 Normal Adrenal On MRI

Adrenal Venography : 

50 Adrenal Venography Selective injection of contrast into the adrenal vein with an angiographic catheter Indication For localization of hormone active tumor For adrenal hyperplasia & adrenal adenoma Cushing’s diseases

Adrenal Venography : 

51 Adrenal Venography Classic gland like pattern of intraglandular rt adrenal vein

Adrenal Venography : 

52 Adrenal Venography Showing rounded configuration of adenoma in lateral limb

Adrenal Venography : 

53 Adrenal Venography Shows extensive destruction of venous structure

Adrenal Arteriography : 

54 Adrenal Arteriography Procedure in which contrast is injected into adrenal arteries to detect any vascular pathology Indication Adrenal tumor Adrenal hyperplasia CONN syndrome

Adrenal scintigraphy : 

55 Adrenal scintigraphy Usual role of scintigraphy is to clarify inconclusive result of imaging Indication Functional status of adrenal nodule Assess contralateral adrenal function Detect functional metastasis Detect recurrence after surgery Detect ectopic site of hormone production

Adrenal Scintigraphy : 

56 Adrenal Scintigraphy Adrenocortical imaging agent NP-59 ( 6-B-iodomethyl-19-norcholesterol ) Selenium-75 6-B-selenomethylnorcholesterol Sympathoadrenal imaging agent MIBG ( metaiodobenzylguanidine )

Adrenal Scintigraphy : 

57 Adrenal Scintigraphy Indication for MIBG Pheochromocytoma Neuroblastoma, carcinoid, adrenal metastasis Indication for NP-59 Adrenocortical carcinoma Adenoma Adrenal hyperplasia

MIBG Scintigraphy : 

58 MIBG Scintigraphy MIBG Scintigraphy: high uptake in LT adrenal ,Pheochromocytoma

MIBG Scintigraphy : 

59 MIBG Scintigraphy MIBG : Inc tracer accumulation in lt adrenal mass

THANK YOU : 

60 THANK YOU

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