This step is critical when resecting large pheochromocytomas because early access to the adrenal vein is essential. Mobilization of the duodenum is also required for easier identification of the right adrenal vein. The right hepatic lobe can be mobilized from the colon and diaphragm by transecting the triangular, coronary, and hepatocolic ligaments, allowing visualization of the right adrenal gland just superior to the upper pole of the right kidney. Access to the right adrenal gland is more easily obtained by entering the retroperitoneum behind the liver. Dissection of the right adrenal gland is limited medially by the duodenum and superiorly by the right hepatic lobe. The right adrenal gland lies superior to the upper pole of the right kidney, posterolateral to the IVC. Preventing intraoperative injury to contiguous structures rests on the surgeon having a thorough knowledge of the anatomic relationships of the adrenal gland (see Fig. However, in the case of renal ectopy, the adrenal remains in its natural position. Each adrenal gland resides within the Gerota fascia with the kidney. The medullary tissue within the gland imparts a unique tripartite structure of the head (most medial), body, and tail (most lateral). The large adrenal size with hypervascularity may predispose to adrenal hemorrhage in the newborn as well as misdiagnosisįor Wilms tumor or neuroblastoma. Rapid regression occurs in the adrenal size during the first month. The 8-week embryo has massive adrenals, approximately the size of the kidney, and they remain enlarged and very vascular until birth. The medulla is derived from neural crest cells, which migrate from the same primordial neural crest giving rise to the sympathetic chain. Of note, the ventral cells of these bodies are the origin of the interstitial cells of the testis or the theca cells of the ovary.

The coelomic mesoderm, specifically the dorsal cells of the blastema cord at the medial aspect of the mesonephric bodies, gives rise to the cortex. The cortex and medulla each have a unique embryologic derivation.

Kidney adrenal gland tumor