克氏外科学19版chapter 41.pdfVIP

CHAPTER 41 THE ADRENAL GLANDS Michael W. Yeh and Quan-Yang Duh history anatomy and embryology normal histopathology biochemistry and physiology adrenal insufficiency diseases of the adrenal cortex diseases of the adrenal medulla other adrenal diseases technical aspects of adrenalectomy HISTORY The adrenal glands were first described by the Italian anatomist Bartolomeo Eustachi in 1563. The German comparative anatomist Albert von K?lliker (1817-1905), who noted the presence of the adrenals in a number of vertebrate species, is credited with first identifying two distinct portions of the adrenal gland, the cortex and the medulla. Although Thomas Addison described the clinical features of primary adrenal failure in 1855, it was not until almost a century later that the adrenal hormones were fully isolated and characterized. Adrenaline (or epinephrine) was first isolated from adrenal extract at the turn of the century. Steroid hormones were crystallized from cortical extract (cortin) by Swiss and American investigators in the 1930s, but their highly similar chemical structures made isolation of the individual compounds challenging. Edward Kendall, Tadeus Reichstein, and Philip Hench jointly received the 1950 Nobel Prize in Physiology or Medicine for their groundbreaking work on the adrenocortical hormones. The Austrian-born endocrinologist Hans Selye first described the stress response in mammals in 1936 and made major contributions to the understanding of the hypothalamic-pituitary-adrenal (HPA) axis. Roger Guillemin, Andrew Schally, and Rosalyn Yalow were awarded the Nobel Prize in Physiology or Medicine in 1977 for characterizing the peptide hormones of the brain that underlie the HPA axis as we now understand it.1,2 ANATOMY AND EMBRYOLOGY General and Developmental Aspects The adrenal glands are paired, mustard-colored structures positioned superior and slightly medial to the kidneys in the retroperitoneal space (Fig. 41-1). They are flattened and roughly pyramidal (