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Left adrenal gland

The left adrenal gland (left suprarenal gland) is a paired endocrine organ located in the left upper retroperitoneum, anteromedial to the upper pole of the left kidney, and adjacent to the spleen, pancreas, and left crus of the diaphragm. It has a crescent or semilunar shape, broader than the right adrenal gland. Like the right gland, it consists of an outer cortex and an inner medulla. The cortex has three zones: zona glomerulosa (mineralocorticoid production), zona fasciculata (glucocorticoid production), and zona reticularis (androgen secretion). The medulla secretes catecholamines (epinephrine and norepinephrine).

Synonyms

  • Left suprarenal gland

  • Left adrenal body

Function

  • Cortex: produces steroid hormones

    • Mineralocorticoids (aldosterone) – regulates sodium, potassium, and water balance

    • Glucocorticoids (cortisol) – regulates metabolism and stress response

    • Androgens – secondary sexual characteristics

  • Medulla: secretes catecholamines (epinephrine, norepinephrine) for fight-or-flight response

  • Plays a vital role in blood pressure regulation, metabolism, immune modulation, and stress adaptation

Arterial Supply

  • Superior suprarenal arteries from the inferior phrenic artery

  • Middle suprarenal artery directly from the abdominal aorta

  • Inferior suprarenal artery from the renal artery

Venous Drainage

  • Drains via a single left suprarenal vein, which empties into the left renal vein (unlike the right, which drains into the IVC)

Nerve Supply

  • Derived from the celiac plexus and abdominal sympathetic plexuses

  • Preganglionic sympathetic fibers (T10–L1) directly innervate the medulla

  • The medulla acts like a modified sympathetic ganglion, releasing catecholamines directly into the bloodstream

MRI Appearance

T1-weighted images:

  • Left adrenal gland appears as a small, triangular to semilunar low-to-intermediate signal structure above the left kidney

  • Fat planes around the gland are hyperintense, aiding visualization

  • Adenomas may appear hypointense, with signal loss on out-of-phase imaging due to intracytoplasmic fat

T2-weighted images:

  • Normal adrenal gland: intermediate signal intensity relative to liver and muscle

  • Adenomas: variable, often low signal

  • Pheochromocytomas: characteristically very hyperintense (“light-bulb bright”)

STIR (Short Tau Inversion Recovery):

  • Suppresses surrounding fat, improving detection of edema, infiltrative lesions, or tumors

  • Pathologies appear hyperintense against suppressed fat background

T1 Post-Contrast (Gadolinium-enhanced):

  • Normal adrenal gland enhances moderately

  • Adenomas typically enhance rapidly but wash out quickly

  • Malignant lesions or pheochromocytomas enhance intensely and heterogeneously

CT Appearance

Non-contrast CT:

  • Left adrenal gland appears as a small, soft tissue density structure superior to the kidney

  • Adenomas: low attenuation (<10 HU if lipid-rich)

  • Calcifications may be present in old infections or tumors

Contrast-enhanced CT (CECT):

  • Shows homogeneous or heterogeneous enhancement depending on lesion type

  • Adrenal adenoma washout CT helps differentiate adenomas (rapid contrast washout) from malignancy or metastases (slow washout)

  • CT is excellent for detecting hyperplasia, adenomas, pheochromocytomas, hemorrhage, or metastasis

MRI images

Left adrenal gland anatomy MRI axial

MRI images

Left adrenal gland anatomy MRI coronal image -img-00000-00000_00001

CT image

Left adrenal gland anatomy CT axial image -img-00000-00000

CT image

Left Adrenal gland ct coronal image

MRI image

Left adrenal gland MRI coronal image anatomy image -img-00000-00000