surgical Aspects of SuprarenalTumours

Abstract

This is a rev1ew that is concerned with the adrenal glands ; their development, gross and microscopic anatomy, physiological considerations, . pathology of adrenal tumours, their clinical presentation, diagnosis,

management and prognosis.

r The adrenal gland consists of a cortex of mesodermal origin and a

medulla of neuroectodermal origin.

The adrenal glands are paired. retroperitoneal organs that lie within the perinephric fat at the anterosuperior and medial aspects of the kidney.

Functionally the adrenal gland can be thought of as two distinct organs : cortex and medulla. Each has its own unique physiology and hormonally active secretory products. From a common precursor, the zones of the adrenal cortex produce a series of steroid hormones that have an array of actions, including salt retention, metabolic homeostasis, and adrenarche development. On the other hand, the adrenal medulla is composed of large chromaffin cells, which primarily secrete epinephrine hut also secrete norepinephrin and dopamine.

Neoplasms of the adrenal glands arise either from the cortex (adenoma and carcinoma), from the medulla (phaeochromocytoma and neuroblastic tumours) or from the connective tissue stroma of the gland.

Suprarenal tumours are either clinically functional, biochemically functional or completely non functional.

Functional adrenal cortical neoplasms are usually manifested by clinical syndromes due to excessive steroid hormone secretion as Cushing's syndrome (due to excessive glucocorticoids), Conn's syndrome (due to excessive aldosterone) and adrenogenital syndrome (due to excessive androgen secretion). Adrenal co1iical tumours are either benign or malignant.