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The adrenal glands are located at the upper margin of the kidneys about the level of the 12th thoracic vertebra. They are composed of two functional parts, the medulla and the cortex. Disease processes of the adrenal glands that may require surgical intervention result from excessive secretion of one or more of these hormones. A secretory tumour of the medulla is known as a phaeochromocytoma, which produces high circulating concentrations of catecholamines. In the cortex, benign secretory adenomas can produce cortisol resulting in high circulating levels (Cushing's disease) or secrete aldosterone (Conn's syndrome). Prolonged treatment with steroids such as prednisolone can produce secondary adrenocortical insufficiency due to suppression of the normal control mechanisms. This results in profound cardiovascular collapse in the perioperative period. This severe complication can be avoided by supplementation with cortisol.
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