20 The right adrenal gland is covered by the caudal extension of the right lateral liver lobe access to the region can be further complicated by hepatomegaly that accompanies hyperadrenocorticism.
In many instances, the adrenal capsule is actually contiguous with vascular adventitia. The right adrenal, which is further cranial than the left, is located ventral to the thirteenth thoracic vertebra and is adhered to the right side of the vena cava. The left adrenal gland is adjacent to the left side of the abdominal aorta medially, and its caudal aspect borders the left renal artery. 20 The left adrenal gland is located medial to the cranial pole of the left kidney and is loosely adhered to fascia of the psoas minor muscle and transverse process of the second lumbar vertebra.
The paired adrenal glands are located in the retroperitoneal space, closely associated with the aorta and vena cava in the cranial abdomen (Figure 120-1). 27 In these instances, proper knowledge of adrenal physiology and perioperative care can improve the chances of a successful patient outcome.
Despite challenges associated with surgery, it is generally agreed that adrenalectomy is indicated in animals with functional tumors and those with characteristics of malignancy. Thus, modern veterinary surgeons are often faced with the difficult task of weighing the risks and benefits of elective adrenalectomy, a procedure with significant perioperative mortality. 27 Unfortunately, the complex anatomy and physiology of the adrenal gland present a variety of challenges at every level, from diagnosis of disease conditions to decision making, perioperative care, and surgery itself. In fact, frequent diagnosis of adrenal masses unrelated to the primary complaint has resulted in a new term in both disciplines-the adrenal incidentaloma. The widespread availability of abdominal ultrasonography has led to increased detection of adrenal masses in human and veterinary medicine.
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