Anatomical Relations of the Adrenal Glands

The adrenal glands (also called suprarenal glands) are retroperitoneal endocrine organs located in the superior aspect of the abdomen. Each gland sits on the superior pole of the corresponding kidney but is separated from it by a layer of perirenal fat. Despite their proximity to the kidneys, the adrenal glands are functionally and developmentally distinct. Their anatomical relations are important in imaging interpretation, surgical planning, and understanding disease spread.

Location and Orientation

• Right adrenal gland: Pyramidal in shape
• Left adrenal gland: Crescentic or semilunar
• Position: Tucked within the renal fascia (Gerota’s fascia), anterior to the diaphragm
• Vertebral level: Approximately T11–L1

Peritoneal Relationships

Both adrenal glands are retroperitoneal structures — they lie behind the parietal peritoneum and are surrounded by perirenal fat, enclosed within the renal fascia.

Right Adrenal Gland – Relations

Surface	Relation
Anterior	Right lobe of the liver (bare area), inferior vena cava (medially), right crus of diaphragm (posterior-medial)
Posterior	Diaphragm (right crus), upper pole of the right kidney
Medial	Inferior vena cava (IVC)
Lateral	Liver
Inferior	Upper pole of the right kidney

Left Adrenal Gland – Relations

Surface	Relation
Anterior (superior part)	Stomach and lesser sac
Anterior (inferior part)	Pancreas, splenic artery, and left gastric vessels
Posterior	Diaphragm (left crus)
Inferior	Upper pole of the left kidney
Lateral	Spleen (superolateral corner)

Vascular Landmarks

• Right adrenal vein: Drains directly into the IVC, very short — located posterior to the IVC
• Left adrenal vein: Longer, drains into the left renal vein; often joined by the inferior phrenic vein
• Middle suprarenal arteries: Originate directly from the abdominal aorta, travel laterally to glands

Ligamentous and Fascial Context

• Surrounded by Gerota’s fascia (renal fascia)
• Not enclosed within the renal capsule; separated from kidney by a layer of perirenal fat
• Attached to the diaphragm via loose areolar tissue

Functional Relevance of Relations

• Right-sided surgery: Close relation to IVC and liver makes right adrenalectomy technically more difficult
• Left-sided surgery: Pancreas and splenic vessels must be mobilized for adequate exposure
• Posterior approach: Diaphragmatic fibers may be dissected to access glands via retroperitoneum
• Metastatic spread: Adrenal tumors may involve adjacent organs such as liver, kidney, pancreas, or diaphragm

Radiological Landmarks

• On CT or MRI, the adrenal glands are often “Y-” or “V-” shaped structures in the perinephric space
• Their relations with the kidney, liver, spleen, stomach, and major vessels assist in identification and pathology localization