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Surgical anatomy of the adrenal glands

Sanziana Roman, MD
Leslie Wu, MD
Section Editor
Sally E Carty, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


The adrenal glands are essential to normal physiologic functioning. Significant pathology requiring surgical intervention may result from hyperplasia, adenoma formation, or malignancy.

Adrenal surgery often is the primary treatment modality for a multitude of adrenal conditions. As a result, a strong working knowledge of adrenal embryology and anatomy is essential. Adrenalectomy can be performed by open or laparoscopic techniques with use of various approaches (anterior, lateral, or posterior) [1,2]. Regardless of the operative approach, the surgeon must have a complete understanding of the anatomy of the adrenal gland to avoid injury to vital adjacent structures and organs [3,4].

This topic will review surgical anatomy of the adrenal glands. Surgical diseases of the adrenal gland, diagnosis, and treatment are discussed elsewhere. (See "Basic principles in the laboratory evaluation of adrenocortical function" and "Clinical presentation and evaluation of adrenocortical tumors" and "Treatment of pheochromocytoma in adults" and "The adrenal incidentaloma".)


The adrenal glands are composed of two functionally distinct endocrine units, the adrenal cortex and medulla, contained within a single capsule (figure 1). Each has distinct embryologic, anatomic, histologic, and functional characteristics [5].

Adrenal cortex function — The adrenal cortex is divided into three functional zones (figure 2).

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Literature review current through: Sep 2017. | This topic last updated: Mar 15, 2017.
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  1. Wells SA, Merke DP, Cutler GB Jr, et al. Therapeutic controversy: The role of laparoscopic surgery in adrenal disease. J Clin Endocrinol Metab 1998; 83:3041.
  2. Barczyński M, Konturek A, Nowak W. Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg 2014; 260:740.
  3. Perrier, ND, Boger, MS. Surgical anatomy. In: Adrenal Glands: Diagnostic Aspects and Surgical Therapy, Linos, D, van Heerden, JA (Eds), Springer, New York 2005. p.7.
  4. Surgical embryology and anatomy of the adrenal glands. In: Textbook of Endocrine Surgery, 2nd edition, Clark, OH, Duh, QY, Kebebew, E (Eds), Elsevier Saunders, Philadelphia 2005. p.557.
  5. Bland ML, Desclozeaux M, Ingraham HA. Tissue growth and remodeling of the embryonic and adult adrenal gland. Ann N Y Acad Sci 2003; 995:59.
  6. Brunt, LM, Halverson, JD. The Endocrine System. In: The Physiologic Basis of Surgery, O'Leary, JP (Eds), Lippincott, Philadelphia 2002. p.351.
  7. Gray, DG, Thompson, NW. Pheochromocytoma. In: Surgical Endocrinology, Doherty, GM, Skogseid, B (Eds), Lippincott, New York 2001. p.247.
  8. Ait-Ali D, Stroth N, Sen JM, Eiden LE. PACAP-cytokine interactions govern adrenal neuropeptide biosynthesis after systemic administration of LPS. Neuropharmacology 2010; 58:208.
  9. Avisse C, Marcus C, Patey M, et al. Surgical anatomy and embryology of the adrenal glands. Surg Clin North Am 2000; 80:403.
  10. Zeiger MA, Thompson GB, Duh QY, et al. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract 2009; 15 Suppl 1:1.
  11. Zeiger MA, Thompson GB, Duh QY, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract 2009; 15:450.
  12. Lombardi CP, Crea C, Pennestri F, et al. Surgical anatomy. In: Surgery of the Adrenal Gland, Valeri A, Bergamini C, Bellantone R, Lombardi CP (Eds), Springer, Milan 2013. p.15.
  13. Moore, KL, Dalley, AF. Clinically Oriented Anatomy, 4th edition, Lippincott, Baltimore 1999. p.279.
  14. Brunt, LM, Moley, J. The pituitary and adrenal glands. In: Sabiston Textbook of Surgery, 17th edition, Townsend, CM, Beauchamp, RD, Evers, BM, Mattox, KL (Eds), Saunders, Philadelphia 2004. p.1023.
  15. Mansmann G, Lau J, Balk E, et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004; 25:309.
  16. Disick GI, Palese MA. Extra-adrenal pheochromocytoma: diagnosis and management. Curr Urol Rep 2007; 8:83.
  17. Whalen RK, Althausen AF, Daniels GH. Extra-adrenal pheochromocytoma. J Urol 1992; 147:1.
  18. Kebebew, E, Duh, QY. Operative strategies for adrenalectomy. In: Surgical Endocrinology, Doherty, GM, Skogseid, B (Eds), Lippincott, New York 2001. p.273.
  19. Honma K. Adreno-hepatic fusion. An autopsy study. Zentralbl Pathol 1991; 137:117.