Left adrenal gland !
The left adrenal gland is a small gland on top of the left kidney, near the aorta; it makes cortisol, aldosterone and adrenaline.
Official name: Suprarenal gland
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What it is
A crescent-shaped gland along the upper inner edge of the left kidney.
What it does
Makes the same hormones as the right one. Its vein drains into the left renal vein.
Key facts
- Where
- Retroperitoneal on the medial border of the left kidney above the hilum, inside renal fascia; crescent-shaped, behind the stomach (lesser sac) and pancreas, beside the aorta
- Blood supply
- Superior (inferior phrenic), middle (aorta) and inferior (renal) suprarenal arteries; one vein into the left renal vein
- Nerve
- Preganglionic sympathetic fibres (T10–L1, via splanchnic nerves) synapse directly on medullary chromaffin cells (some texts: T8–L1)
- Function
- Cortex: aldosterone (glomerulosa), cortisol (fasciculata), androgens (reticularis); medulla: adrenaline and noradrenaline
Relations
- In front
- Stomach across the lesser sac above; body of the pancreas and the splenic artery and vein below
- Behind
- Left crus of the diaphragm
- Medial
- Abdominal aorta and the left celiac ganglion
- Lateral
- Upper medial border of the left kidney, down to near the hilum
How to find it
Not palpable. In surgery it is reached by moving the spleen and the tail of the pancreas forward and medially, or from behind; its vein, followed up from the left renal vein, leads to it.
On imaging
On CT it looks like an inverted Y or V. A smooth nodule with low attenuation on non-contrast CT (10 HU or less) is typical of a lipid-rich adenoma; larger, heterogeneous or growing masses need further study. Chemical-shift MRI shows signal loss in adenomas.
Common problems
- Small nodules found by chance on CT (incidentalomas), mostly harmless.
- Tumours that make too much hormone (high blood pressure, Cushing syndrome).
How it is diagnosed
Blood and urine hormone tests; CT or MRI.
Treatment
- Monitoring, medicines, or laparoscopic removal (adrenalectomy).
Clinical notes
- Incidentalomas are tested for hormone excess (cortisol, aldosterone, catecholamines) and judged on size and imaging features
- In pheochromocytoma surgery the adrenal vein is tied early to limit the catecholamine surge from handling the tumour
- In left adrenalectomy the longer vein is easier to control than on the right, but the pancreas tail and splenic vessels lie close
Anatomical variants
- Accessory cortical nodules are often found in the connective tissue around the gland; after bilateral adrenalectomy for ACTH-dependent Cushing disease, a missed nodule can keep making cortisol
Development
The cortex comes from mesoderm (coelomic epithelium); the medulla from neural crest cells, the source of pheochromocytoma and, in children, neuroblastoma.
Memory aid
Cortex from outside in, "GFR – salt, sugar, sex": glomerulosa (aldosterone), fasciculata (cortisol), reticularis (androgens).
Related conditions
- Cushing syndrome
- Phaeochromocytoma
- Adrenal insufficiency
- Hereditary paraganglioma and pheochromocytoma (SDH)
- X-linked adrenoleukodystrophy
- Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
- Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency
- Congenital adrenal hyperplasia due to 17α-hydroxylase deficiency
- Adrenal crisis
- Primary hyperaldosteronism (Conn syndrome)
- Adrenal incidentaloma
- Autoimmune polyendocrine syndromes (APS-1, APS-2) and IPEX
- Adrenocortical carcinoma
- Meningococcal disease (meningococcemia)
- Bartter, Gitelman and Liddle syndromes
- Neuroblastoma
Test yourself
Think of the answer, then tap the question to see it.
Where does the left adrenal vein drain?
Into the left renal vein; it is long, so left adrenal vein sampling and control at left adrenalectomy are usually easier than on the right.
Which hormones does each zone of the adrenal cortex make, from outside in?
Zona glomerulosa: aldosterone; zona fasciculata: cortisol; zona reticularis: androgens. The medulla makes adrenaline and noradrenaline.
What is the embryological origin of the adrenal cortex and medulla?
Cortex from mesoderm (coelomic epithelium); medulla from neural crest cells, the source of pheochromocytoma and, in children, neuroblastoma.
Why is adrenal vein sampling done in primary aldosteronism (Conn syndrome)?
To separate a one-sided adenoma, which surgery can cure, from bilateral hyperplasia.
Which CT feature is typical of a lipid-rich adrenal adenoma?
A smooth nodule with low attenuation on non-contrast CT (10 HU or less); larger, heterogeneous or growing masses need further study.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- glandula suprarenalis TA2 3874
- Official Spanish (DeCS)
- Glándulas suprarrenales DeCS D000311
- English (TA2)
- Suprarenal gland
- Also called
- adrenal gland · adrenal glands · corpus suprarenale · left suprarenal gland
Related
Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis: Adrenal Glands (Suprarenal Glands); Anatomy of the Human Body (20th ed.): The Chromaphil and Cortical Systems (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain.
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Representative model, for educational purposes only.