Sectional Anatomy

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Sectional Anatomy

• Adrenal

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Adrenal

• Paired retroperitoneal structures also known as
  suprarenal glands
• Covered by a fibrous capsule
• Hypoechoic structures surrounded by echogenic
  fat
• Basically triangular shaped found anterior to the
  diaphragmatic crus
• Adrenals are proportionally larger at birth, L
  .8-1cm x AP 3-6 mm x W 2-4 cm
• Found at the superior aspect of each kidney
  within the renal fascia

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Adrenal

• Stimulated by the anterior pituitary gland
• Adrenal glands consist of two distinct endocrine
  organs, the cortex the medulla
• Medulla
• Echogenic central linear structure within the
  adrenal
• Secretes catecholamines
• Cortex
• Hypoechoic outer region surrounding the echogenic
  medulla
• Secretes steroids

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Adrenal Cortex

• Produces steroid hormones to regulate
• Electrolyte metabolism
• Carbohydrate metabolism
• Secretion of androgens estrogen's
• Adrenal cortical hormones are regulated by (ACTH)
  Adrenocorticotropic hormones of the pituitary
  gland

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Adrenal Cortex

• Adrenal cortex can be affected by lesions that
  produce an excess or a deficiency of steroid
  hormones
• Remember adrenocortical hormones may be altered
  as a result of an over or underproduction of ACTH
  that is a result of a pituitary tumor

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Lab Values

• Adrenocorticotropic Hormone (ACTH)
• Hormone released by anterior pituitary,
  stimulates adrenal cortex to secrete cortisol,
  androgens and aldosterone
• Aldosterone
• Secreted by adrenal cortex it helps to maintain
  blood pressure
• Elevates with adrenocortical hyperplasia, adenoma
  and adrenal CA
• Decreases with Addisons Disease

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Lab Values

• Cortisol
• Secreted by the adrenal cortex and helps to
  metabolize nutrients
• Increases with adrenal hyperfunction (Cushings
  disease) and hyperthyroidism
• Decreases with adrenal hypofunction (Addisons
  disease)

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Right Adrenal Gland
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Adrenal Medulla

• Produces catecholamines like epinephrine
  (adrenaline) and norepinephrine.
• Epinephrine dilates the coronary vessels
  constricts the skin kidney vessels
• Epinephrine increases coronary output which
  raises the oxygen consumption can cause
  hypercalcemia

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Adrenal Medulla

• Epinephrine is responsible for the ' fight or
  flight" response
• Norepinephrine constricts all arterial vessels
  except the coronary arteries, it also regulates
  blood pressure

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Newborn adrenal gland
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Adrenal
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Ultrasound Findings

• Triangular shaped structures
• Superior anterior medial to the upper pole of
  the kidneys
• Measure approximately 1 cm x 6 mm x 6 mm
• More noticeable in the fetus and infant
• Right adrenal is identified superior to the
  kidney lateral to the crus of the diaphragm and
  is Y or V shaped
• Right adrenal lies posterior to the IVC
  anterior to the right crus of the diaphragm

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Adrenals
?
?
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Sagital Right Adrenal
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Right Adrenal
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Right Adrenal
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Right Adrenal
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Ultrasound Findings

• Left adrenal is lateral to the crus of the
  diaphragm posterior-lateral to the Aorta
  superior to the left kidney and is triangular
  shaped
• Left adrenal gland lies between the spleen the
  aorta and posterior to the tail of the pancreas

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Adrenals
?
?
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Left Adrenal
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Adrenal Glands
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Left Adrenal
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Left Adrenal
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Left Adrenal
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Technique

• Transverse and sagittal planes in both supine and
  decubitus positions can be used
• In transverse, find the IVC angle posterior to
  find the superior pole of the right kidney, you
  should see the adrenal between the IVC and
  superior pole of the right kidney
• In sagittal you should see the right adrenal
  posterior the IVC and anterior to the right crus

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Technique

• In transverse find the aorta, superior pole of
  the left kidney and left diaphragmatic crus
• The adrenal lies medial to the upper pole and
  lateral to the aorta anterior to the crus

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Associated Anomalies

• Cortex
• Adenomas
• Carcinomas
• Hyperplasia
• Medulla
• Ganglioneuroma
• Neuroblastoma
• Pheochromocytoma