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1. ANATOMY OF SUPRARENAL (ADRENAL) GLANDS Adnan Nazir Suman Seed Ur Rehman Shah Saood Zahir Hussan

2. Objectives At the end of the presentation ,we should be able to describe the: Location, shape and relations of the right and left adrenal glands. Blood supply, lymphatic drainage and nerve supply of right and left adrenal glands Parts of adrenal glands and function of each part. Development of adrenal gland and common anomalies. Dr Ndayisaba Corneille

3. Suprarenal Glands The suprarenal (adrenal) gland is a component of the hypothalamic-pituitary-suprarenal axis that is responsible for coordinating stress response and metabolism . They are yellowish retroperitoneal organs that lie on the upper poles of the kidneys, just above the level of the last thoracic vertebra (T12). They are surrounded by renal fascia (but are separated from the kidneys by the perirenal fat ). Each gland has an outer yellow cortex and an inner dark brown medulla.

4. Suprarenal glands surrounded by connective tissue containing considerable perinephric fat Suprarenal glands are enclosed by renal fascia by which they are attached to the crura of the diaphragm Each gland has a hilum, where the veins and lymphatic vessels exit the gland; whereas arteries and nerve enter the glands at multiple sites They are separated from the kidneys by a thin septum (part of the renal fascia ) The medial borders of the suprarenal glands are 4-5 cm apart. In this area, from right to left, are the IVC, right of the diaphragm, celiac ganglion, celiac trunk, SMA and the left of the diaphragm. Suprarenal Glands

5. The right suprarenal gland Is pyramid shaped. Caps the upper pole of the right kidney. Relations: Anterior : right lobe of the liver and inferior vena cava. Posterior : diaphragm.

6. The left suprarenal gland Is crescentic in shape Extends along the medial border of the left kidney from the upper pole to the hilus . Relations: Anterior : pancreas, lesser sac, and stomach opsterior : diaphragm.

7. PARTS OF SUPRA RENAL GLANDS Each suprarenal gland has two parts : ~ Suprarenal cortex ~ Suprarenal medulla

8. SUPRARENAL CORTEX Derives from mesoderm

9. include cortisol (hydrocortisone), corticosterone, an d cortisone Function : Protein breakdown, glucose formation, lipolysis, resistance to stress, anti-inflammatory effects, depression of immune responses Glucocorticoid

10. The major androgen secreted b y the adrenal gland is dehydroepiandrosterone (DHEA) Function : promote libido (sex drive) and are converted into estrogens (feminizing sex steroids) by other body tissues ; after menopause, when ovarian secretion of estrogens ceases all female estrogens come from conversion of adrenal androgens ; stimulate growth of axillary and pubic hair in boys and girls and contribute to the prepubertal growth spurt. Androgen

11. SUPRARENAL MEDULLA Derive from neural crest cells associated with the sympathetic nervous system The cromaffin cells secrete catecholamines / epinephrine and norepinephrine (NE), also called adrenaline and noradrenaline, respectively. Unlike the hormones of the adrenal cortex, the hormones of the adrenal medulla are not essential for life since they only intensify sympathetic responses in other parts of the body.

12. Action of catecholamine : Increased heart rate Increased force of cardiac muscle contraction Elevated blood pressure Increased breathing rate Decreased activity in the digestive system

13. Arteries : The arteries supplying each gland are three in number: superior, middle, and inferior suprarenal arteries arise from; inferior phrenic artery , abdominal aorta , and renal artery , respectively. Veins : A single vein emerges from the hilum of each gland and drains into the inferior vena cava on the right and into the left renal vein on the left.

14. Nerve Supply : Preganglionic sympathetic fibers derived from the splanchnic nerves supply the glands. Most of the nerves end in the medulla of the gland. Lymph Drainage : The lymph drains into the lateral aortic nodes.

15. Functions The cortex of the suprarenal glands secretes hormones that include: Mineral corticoids , which are concerned with the control of fluid and electrolyte balance Glucocorticoids , which are concerned with the control of the metabolism of carbohydrates, fats, and proteins Small amounts of sex hormones , which probably play a role in the prepubertal development of the sex organs. The medulla of the suprarenal glands secretes the catecholamines: epinephrine and norepinephrine

16. Development of the Adrenal Glands The two parts of the adrenal gland i.e. the cortex and the medulla develop from two different origins. Cortex is mesodermal in origin; develops from the celomic epithelium of the posterior abdominal wall . Medulla is ectodermal in origin; develops from the neural crest cells.

17. The cortex During the 6th week of development, by aggregation of the mesenchymal cells between dorsal mesentery and developing gonads. This fetal cortex is derived from the mesothelium lining the posterior abdominal wall. The medulla It forms a mass medial to the fetal cortex derived from the adjacent sympathetic ganglion; from neural crest cells.

18. Permanent cortex A second wave of mesenchymal cells arise from the mesothelium, enclose the fetal cortex. forms a thinner definitive (permanent) cortex.

19. Differentiation of the characteristic suprarenal cortical zones begins during the late fetal period. Zona glomerulosa & zona fasciculata are present at birth, but zona reticularis is not recognizable until the end of third year.

20. The suprarenal gland of the fetus is 10-20 times larger than the adult glands relative to the body weight, and are large compared with the kidneys. This is because of the extensive size of the fetal cortex. The medulla remains relatively small until after birth. The suprarenal glands rapidly become smaller during the first 2-3 weeks after birth, due to the rapid regression of the fetal cortex. Its involution is largely completed in the first year of life. During the process of involution, the cortex is friable and susceptible to trauma at birth leading to severe hemorrhage. Congenital adrenal hyperplasia (CAH): An abnormal increase in the cortical cells results in excessive androgen production; during the fetal period. In females , it may lead to musculization of external genitalia and enlargement of clitoris. In males, it may remain undetected in early infancy. Later in childhood , in both sexes, androgen excess may lead to rapid growth and accelerated skeletal maturation .

21. END THANK YOU