The adrenal glands are two small organs, one located above each kidney. They are triangular in shape and about the size of a thumb. The adrenal glands are known as endocrine glands because they produce hormones. These hormones are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the “fight or flight” reaction during times of stress. These adrenal-produced hormones include cortisol, aldosterone, the adrenaline hormones – epinephrine and norepinephrine – and a small fraction of the body’s sex hormones (estrogen and androgens).
WHAT CAUSES ADRENAL GLAND PROBLEMS?
Diseases of the adrenal gland are relatively rare. The most common reason that a patient may need to have the adrenal gland removed is excess hormone production by a tumor located within the adrenal. Most of these tumors are small and not cancers. They are known as benign growths that can usually be removed with laparoscopic techniques. Removal of the adrenal gland may also be required for certain tumors even if they aren’t producing excess hormones, such as very large tumors or if there is a suspicion that the tumor could be a cancer, or sometimes referred to as malignant. Fortunately, malignant adrenal tumors are rare. An adrenal mass or tumor is sometimes found by chance when a patient gets an X-ray study to evaluate another problem.
WHAT ARE THE SYMPTOMS OF ADRENAL GLAND PROBLEMS?
Patients with adrenal gland problems may have a variety of symptoms related to excess hormone production by the abnormal gland. Adrenal tumors associated with excess hormone production include pheochromocytomas, aldosterone-producing tumors, and cortisol-producing tumors. Some of these tumors and their typical features are given below.
Pheochromocytomas produce excess hormones that can cause very high blood pressure and periodic spells characterized by severe headaches, excessive sweating, anxiety, palpitations, and rapid heart rate that may last from a few seconds to several minutes.
Aldosterone producing tumors cause high blood pressure and low serum (blood) potassium levels. In some patients this may result in symptoms of weakness, fatigue, and frequent urination.
Cortisol producing tumors cause a syndrome termed Cushing’s syndrome that can be characterized by obesity (especially of the face and trunk), high blood sugar, high blood pressure, menstrual irregularities, fragile skin, and prominent stretch marks. Most cases of Cushing’s syndrome, however, are caused by small pituitary tumors and are not treated by adrenal gland removal. Overall, adrenal tumors account for about 20% of cases of Cushing’s syndrome.
An incidentally found mass in the adrenal may be any of the above types of tumors, or may produce no hormones at all. Most incidentally found adrenal masses do not make excess hormones, cause no symptoms, are benign, and do not need to be removed. Surgical removal of incidentally discovered adrenal tumors is indicated only if:
The tumor is found to make excess hormones
Is large in size (more than 4-5 centimeters or 2 inches in diameter)
If there is a suspicion that the tumor could be malignant.
Adrenal gland cancers (adrenal cortical cancer) are rare tumors that are usually very large at the time of diagnosis. Removal of these tumors is usually done by open adrenal surgery.
If an adrenal tumor is suspected based on symptoms or has been identified by X-ray, the patient should undergo blood and urine tests to determine if the tumor is over-producing hormones.
Special X-ray tests, such as a CT scan, nuclear medicine scan, an MRI or selective venous sampling are commonly used to locate the suspected adrenal tumor.
Surgical removal of the adrenal gland is the preferred treatment for patients with adrenal tumors that secrete excess hormones and for primary adrenal tumors that appear malignant.
Laparoscopic Adrenal Gland Removal
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC ADRENAL GLAND REMOVAL?
In the past, making a large 6 to 12 inch incision in the abdomen, flank, or back was necessary for removal of an adrenal gland tumor. Today, with the technique known as minimally invasive surgery, removal of the adrenal gland (also known as “laparoscopic adrenalectomy”) can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery. Results of surgery may vary depending on the type of procedure and the patients overall condition.
Common advantages are:
Less postoperative pain
Shorter hospital stay
Quicker return to normal activity
Improved cosmetic result
Reduced risk of herniation or wound separation
ARE YOU A CANDIDATE FOR LAPAROSCOPIC ADRENAL GLAND REMOVAL?
Although laparoscopic adrenal gland removal has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by a surgeon qualified in laparoscopic adrenal gland removal in consultation with your primary care physician or endocrinologist to find out if the technique is appropriate for you.
WHAT PREPARATION IS REQUIRED?
Prior to the operation, some patients may need medications to control the symptoms of the tumor, such as high blood pressure.
Patients with a pheochromocytoma (see previous page) will need to be started on special medications several days prior to surgery to control their blood pressure and heart rate.
Patients with an aldosterone-producing tumor (see previous page) may need to have their serum potassium checked and take extra potassium if the level is low.
Patients with Cushing’s syndrome (see previous page) will need to receive extra doses of cortisone medication on the day of surgery and for a few months afterwards until the remaining adrenal gland has resumed normal function.
Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
Blood transfusion and/or blood products may be needed depending on your condition.
It is recommended that you shower the night before or morning of the operation.
After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
Drugs such as blood thinner, anti-inflammatory medications and large doses of Vitamin E may need to be stopped temporarily for a short time period before surgery.
Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
Quit smoking and arrange for any help you may need at home.
Laparoscopic Adrenal Gland Removal Procedure
HOW IS LAPAROSCOPIC ADRENAL GLAND REMOVAL PERFORMED?
The surgery is performed under a complete general anesthesia, so that the patient is asleep during the procedure.
A cannula (a narrow tube-like instrument) is placed into the abdominal cavity in the upper abdomen or flank just below the ribs.
A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula. This gives the surgeon a magnified view of the patient’s internal organs on a television screen.
Other cannulas are inserted which allow your surgeon to delicately separate the adrenal gland from its attachments. Once the adrenal gland has been dissected free, it is placed in a small bag and is then removed through one of the incisions. It is almost always necessary to remove the entire adrenal gland in order to safely remove the tumor.
After the surgeon removes the adrenal gland, the small incisions are closed.
10 common question about adernal surgery
1How long does it take to recover from adrenal gland surgery?
Most patients take 1 to 2 weeks to recover from the laparascopic surgery and 5 to 6 weeks from an open adrenalectomy.
2Is adrenal gland surgery dangerous?
Adrenal insufficiency is a life-threatening condition where the body is not making enough steroids. Patients that get only one of the adrenal glands surgically removed and their other adrenal gland is normal have a low risk of developing adrenal insufficiency.
3Who does surgery on adrenal glands?
Adrenalectomy is the surgical removal of the adrenal gland with the tumor. This may be needed to treat an adrenal gland tumor. A surgical endocrinologist is a surgeon who specializes in treating an endocrine tumor using surgery.
4What happens when the adrenal gland is overactive?
Overactive Adrenal Gland Disorders
A tumor of the adrenal glands can result in the overproduction of various hormones. Pheochromocytoma, a rare, usually benign, tumor of the adrenal glands resulting in the glands secreting excessive amounts of the hormones adrenaline and noradrenaline (catecholamines).
5What happens when an adrenal gland is removed?
Adrenalectomy is the removal of one or both of the adrenal glands. ... Sometimes an adrenal tumor forms on the glands and cause the increase in hormone production. When this happens, the gland needs to be removed. The usual recovery time after surgery is 2 to 6 weeks.
6How long does adrenal surgery take?
Laparoscopic surgery usually takes anywhere from one to three hours once you are asleep, depending on the type of surgery you are having and the difficulty of the case.
7Can you live without cortisol?
The adrenal glands are small glands located on top of each kidney. They produce hormones that you can't live without, including sex hormones and cortisol. ... In Cushing's syndrome, there's too much cortisol, while with Addison's disease, there is too little. Some people are born unable to make enough cortisol.
8What is the life expectancy of someone with adrenal cancer?
Unfortunately, 60 to 70% of patients have stage III or IV disease at the time of diagnosis. The 5-year survival refers to the percent of patients on average who are alive 5 years after their diagnosis. After a recurrence of adrenal cancer, virtually all patients die within five years.
9Are adrenal glands removed with kidneys?
In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland.
10Should adrenal gland tumors be removed?
The most common reason that a patient may need to have the adrenal gland removed is excess hormone production by a tumor located within the adrenal. Most of these tumors are small and not cancers. They are known as benign growths that can usually be removed with laparoscopic techniques.