The adrenal cortex is responsible for the secretion of three classes of steroids, glucocorticoids, mineralocorticoids and androgens (sex hormones). 1 The adrenal medulla and the catecholamines that it secretes are not discussed further as they are beyond the scope of this review, which focuses on the adrenocortical function. Medullary tissue is also located at extra-adrenal sites along the course of the abdominal aorta. It is unclear which types of cells secrete dopamine. Approximately 90% of cells are epinephrine secreting, while the remainder are norepinephrine secreting. Pre-ganglionic, cholinergic, sympathetic nerve fibres richly innervate it.

The adrenal medulla is a modified sympathetic ganglion comprising 30% of the adrenal gland. 3 Venous drainage is via a single adrenal vein into the renal vein on the left and the inferior vena cava on the right. The medulla receives blood rich in corticosteroids from the cortex this regulates the synthesis of the enzymes that convert norepinephrine into epinephrine. 1 2 The adrenal glands are densely vascularized, the arterial blood supply reaching them from branches of the renal and phrenic arteries and the aorta. The medullary portion consists of chromaffin cells derived from the ectodermal cells of the neural crest. The adrenal cortex and medulla have distinct embryological origins. The adrenal glands lie on the superior aspect of the kidneys and consist of two endocrine organs: the inner adrenal medulla and the outer adrenal cortex. Postoperative mineralocorticoid and glucocorticoid supplementation should be considered in Addison's disease and in steroid-induced hypoadrenalism. Preoperative preparation involves correction of volume deficit and electrolyte disturbances, and replacement of deficient hormones.Ĭardiovascular disturbance and instability are particularly common and invasive cardiovascular monitoring should be considered. Preoperative assessment is of crucial importance in identifying the endocrine disease process and the severity of its effects. Adrenocortical disease results in disturbances of body water volume and electrolyte concentrations intra-cellular electrolyte defects may be severe.

Aldosterone adrenal cortex