sanjeev

Introduction

Development
Dimension Relations

Structure
Blood supply Histology

Imaging investigations

 A PAIR OF ENDOCRINE

GLANDS MADE - OF TWO PARTS CORTEX AND MEDULLA

 CORTEX Mesoderm of coelomic epithelium MEDULLA- Derived from neural crest cells

(NEUROECTODERM)

 LOCATION

In the epigastrium at the upper pole of the kidney front of the crus of the diaphragm , opposite the vertebral end of the 11th intercostal space and the 12 th rib.

 50mm x 30 mm x 10mm

1/3 of kidney at birth,1/30 in adults

5 grams Right Triangular or pyramidal

Left semilunar
Sheath

 CORTEX AND MEDULLA (1/10 th cortex ) TWO PARTS ARE DISTINCT FROM EACH

OTHER STRUCTURALLY, FUNCTIONALLY AND DEVELOPMENTALLY FASCICULATA, RECTULARIS

CORTEX- ZONA GLOMERULOSA ,

MEDULLA CHROMAFFIN CELLS THAT

SECRETE ADRENALIN AND NON ADRENALIN

 LYMPHATICS Lateral aortic nodes NERVE SUPPLY- Supra renal medulla has a rich nerve

supply through PREGANGLIONIC sympathetic fibers

ACCESSORY SUPRARENAL GLANDS

Small masses of cortical tissue In spermatic cord, epididymis, broad ligament of uterus

 CORTEX-

ZONA GLOMERULOSA - Columnar cells with spherical nuclei ZONA FASCICULATA Cells in vertical rows lot of vacuoles in cytoplasm ZONA RECTULARIS- Cells in anastomosing network, less vacuolated MEDULLA Chromaffin cells, surrounded by capillaries in between cells are autonomic ganglion cells

X-Ray Intravenous urography Retroperitoneal air insufflation Arteriography Phlebography Inferior vena cavography Hormone assay Ultrasound C T scanning MRI Needle biopsy Radio nuclide scanning

 DETECTING MASS Large or small

Masses less than 5 cm cannot be visualized

Differential diagnosis

1.Renal cyst or tumours 2.Spleen or accessory spleen 3.Pancreatic cyst or tumour 4.Liver mass 5.Para aortic glands 6.Retropertional tumour 7.Stomach mass

 CALCIFICATION

1.Idiopathic 2.Neoplasm - irregular 3.Granuloma 4.Cyst - marginal 5.Old hemorrhage 6.Wolman disease - stippled

 Suspected adrenal tumours Differentiate mass in upper pole of

kidney/Adrenal
High dose urography with Tomography

 Used in 1950s Demonstration of adrenal masses

Not accurate with small masses

Fatalities from air embolism

 Renal artery involvement in phaeochromocytoma Ectopic tumours

 Selective adrenal vein phlebography Small tumours of Primary hyperaldosternism

Care must be taken not to overfill the glands , right

more than 2 ml and left more than 5 ml

Excessive contrast will lead to infraction

 Large ectopic pheochromocytoma

 Taking samples from the various sites When other techniques have failed to localize tumour

Renal veins ,high and low in inferior vena cava ,

superior vena cava , iliac veins

Useful in pheochromocytoma , conns tumours

 Only for large adrenal masses Investigation of choice in infants , children and

pregnant women

THANK YOU