Adrenal glands are a pair of small glands just above each kidney that produce important hormones. Adrenal tumors are uncommon, and most are not cancerous. But tumors can cause adrenal glands to make too many hormones, causing troubling symptoms. Adrenalectomy is surgery to remove one or both adrenal glands.

What is an adrenalectomy?

Adrenalectomy is surgery to remove one or both adrenal glands.

What are the adrenal glands?

The adrenals are small glands just above each kidney. They are part of your endocrine system, which creates hormones that affect growth, development, sexual function and metabolism. The adrenal glands produce sex hormones, adrenaline and cortisol.

Why is an adrenalectomy performed?

Problems with the adrenal glands are pretty rare. Sometimes, though, an adrenal tumor that may or may not produce excessive hormones can develop. For tumors that produce excessive hormones, a surgeon must remove the gland and tumor so that hormone levels can get back within normal ranges. For some of the tumors that are not producing hormones, but are suspicious for cancer, likewise, the tumor needs to be surgically removed.

What symptoms can adrenal problems cause?

Although adrenal tumors are rarely cancerous, increased hormones may lead to health problems, such as:

• Anxiety.
• Excessive sweating (hyperhidrosis).
• Fatigue.
• Frequent urination.
• Headaches.
• Heart palpitations or rapid heart rate.
• High blood pressure (hypertension).
• Excess weight (obesity).
• Muscle weakness.

Cushing’s syndrome (hypercortisolism) may occur when the adrenal glands make too much cortisol (also known as the “stress hormone”) for a long time. If left untreated, Cushing’s syndrome can be life-threatening.

Primary hyperaldosteronism may occur when the adrenal produces a blood pressure hormone called “aldosterone” which can lead to salt wasting and high blood pressure resistant to medications.

Pheochromocytoma is a condition related to over production of another group of blood pressure hormones called “catecholamines and metanephrines”. It can lead to a life-threatening high blood pressure problem.

In addition to these more common hormonal syndromes, over production of sex steroids can lead to excessive hair growth and virilization.

PROCEDURE DETAILS

How is adrenalectomy done?

The surgeon will operate in one of two ways:

• Open adrenalectomy:- Your surgeon may use open surgery if the tumor is large or might be cancerous. The surgeon makes an open large incision (cut) in the abdomen to remove the gland(s).
• Laparoscopic adrenalectomy:- More commonly, the surgeon makes a few small incisions and performs a minimally invasive procedure. This method uses a laparoscope, a thin tube equipped with a tiny video camera so the surgeon can see inside the body. Robotic surgery uses the same incisions, but uses wristed, rather than rigid instruments. Whether laparoscopic or robotic, the procedure can either be done by placing the incisions on the back (posterior approach) or on the side (lateral approach). Both procedures are equally successful, with the back approach providing advantages of not entering the abdomen. The back approach is also preferred in patients with a history of prior upper abdominal incisions and 2-sided tumors. Due to the small working space with the back approach, only tumors smaller than 6 cm are approached through the back.

Does adrenalectomy remove one gland or both?

The surgeon may remove only the tumor, one gland or both. Surgery that removes one gland is a unilateral adrenalectomy. A bilateral adrenalectomy removes both glands. People with a diagnosis of cortisol excess (Cushing’s syndrome may take a hydrocortisone supplement for about a year after surgery, until the remaining gland starts making enough hormone on its own. For other patients, testing is done after the surgery to decide if the patients need to be on steroid replacement.

How can I prepare for adrenalectomy?

Follow the advice from your healthcare providers. Your healthcare team may advise you to:

• Stop taking certain medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs), which can interfere with blood clotting.
• Restrict food and water the day before surgery.
• Take medication to control high blood pressure before surgery.

RISKS / BENEFITS

What are the risks and possible complications of adrenalectomy?

As with any surgical procedure, complications may occur. They are more likely with open adrenalectomy than with laparoscopic adrenalectomy.

Laparoscopic adrenalectomy leaves smaller scars, causes less pain and carries fewer risks. Patients who have laparoscopic adrenalectomy have a shorter hospital stay. They can usually get back to their usual activities faster. Still, your surgical team will monitor you for:

• Bleeding and blood clots.
• Damage to nearby organs.
• Hernia.
• Infection.
• Reactions to anesthesia.
• Problems with wound healing.