Adrenal Surgery for Cushing’s

Abstract

In order to safely resect the adrenal glands in the setting of Cushing’s disease or syndrome, it is imperative that the surgeon has a good understanding of the anatomy of these glands. The two adrenal glands are located in the retroperitoneum above and slightly medial to the upper poles of the kidney. The weight of a normal adrenal gland is usually in the range of 3–5 grams. On sectioning, adrenal glands are seen to grossly consist of an outer cortical and an inner medullary layer. The blood supply to each adrenal gland is supplied by branches of the inferior phrenic artery, the aorta and the renal artery. Practically, these tend to manifest as inferior, middle, and superior vascular bundles approaching the adrenal gland from the medial side. On the right, venous drainage is primarily through the very short adrenal vein originating from the medial aspect of the adrenal gland and draining directly into the vena cava. The surgeon needs to be especially wary of an occasional vein originating from the superior medial aspect of the adrenal gland and draining into the right hepatic vein. The primary venous drainage from the left adrenal gland is via a long left adrenal vein draining into the superior aspect of the left renal vein. There can also be significant venous drainage into diaphragmatic branches of the phrenic vein running along the medial aspect of the left adrenal gland and additional venous branches draining into the renal vein can occur on both the right and left sides.