Adrenalectomy Procedure
Overview
Adrenal gland removal, also known as adrenalectomy, is a surgical operation that removes one or both adrenal glands. These glands sit just above each kidney and belong to the endocrine system. Despite their small size, adrenal glands play a big role in the body, as they produce hormones that help control important functions such as blood pressure, metabolism, immune response, and blood sugar levels.
Surgeons usually perform this surgery to address growths or tumors within the adrenal glands. Most of these tumors are not cancerous, but removing them can prevent health issues related to hormone imbalance. Sometimes, doctors operate because the gland is producing too many hormones, which can harm the body’s normal processes.
Rarely, doctors remove an adrenal gland if cancer from another part of the body spreads to it. The outcome after adrenal surgery depends on how many glands doctors remove and the reason for removal:
| Number of Glands Removed | Hormone Treatment Needed |
|---|---|
| One (normal hormone level) | Usually not needed. |
| One (overproducing hormones) | May be needed temporarily until the body adjusts. |
| Both | Needed for life to replace missing hormones. |
If only one adrenal gland is removed and hormone levels were normal, the other gland often adapts and takes over hormone production. However, if both glands are removed, ongoing medication is necessary to replace the hormones that the glands would normally make.
Reasons Doctors Recommend Adrenal Gland Removal
Doctors recommend removing one or both adrenal glands for several reasons. The most common is the presence of a tumor. These growths can be either malignant (adrenal cancer) or benign. While most tumors found in the adrenal glands are not cancer, even non-cancerous tumors may cause health issues if they affect hormone production.
Overproduction of hormones is another key reason. Certain tumors, such as pheochromocytoma, can cause the adrenal glands to make too much hormone. This can lead to symptoms like high blood pressure, headaches, and sweating. Other tumors may cause excess cortisol, resulting in a condition called Cushing syndrome.
In rare situations, pituitary gland problems can also lead to abnormal hormone output from the adrenal glands. If pituitary surgery is not possible or fails, removing the adrenal glands might be necessary. Imaging tests, such as CT or MRI scans, may show unusual or unclear results in the adrenal glands. When this happens, doctors might suggest adrenal gland removal to prevent further complications or to better understand what is causing the changes.
Possible Complications
Common risks of adrenal surgery include:
- Bleeding
- Infection
- Blood clots
- Injury to nearby organs
- Lung problems (such as pneumonia or pneumothorax)
- Blood pressure changes
- Low hormone levels after surgery
Some people may also experience a return of the medical problem that required surgery, or find the surgery does not fully resolve their symptoms.
| Risk | Description |
|---|---|
| Bleeding | Excess bleeding during or after surgery |
| Infection | Wound or deeper infections |
| Blood clots | Clots may form in veins |
| Lung problems | Includes pneumonia, atelectasis, or pneumothorax |
| Organ injury | Accidental harm to nearby organs |
Steps to Get Ready
Before the operation, patients often need to have their blood pressure checked regularly. Sometimes, a special diet or certain medications are recommended to help prepare for surgery. Doctors also use imaging tests to plan the operation, especially if they plan to use a laparoscope and video camera.
If the body is making extra hormones, it’s important to follow the healthcare provider’s directions exactly. Most people are told not to eat or drink for several hours before the procedure. Since doctors usually use general anesthesia for this surgery, patients should arrange for someone to take them home after the operation.
What You Can Expect
While the Operation Is Happening
Surgeons typically remove adrenal glands while the patient is under general anesthesia. This means the person is fully asleep and will not feel pain or be aware during the surgery. Surgeons use two main methods: minimally invasive surgery and open surgery. Minimally invasive methods include:
- Laparoscopic Surgery: The surgeon creates one to four small openings in the belly. A tiny camera (laparoscope) goes in through one of these cuts. Special surgical tools enter through the other cuts to remove the adrenal gland. This technique often leads to smaller scars, less postoperative pain, and a faster recovery than open techniques.
- Posterior Retroperitoneoscopic Surgery (PRA): The surgeon makes small incisions in the back rather than the front of the body and removes the gland through these openings.
- Robotic Procedures: Some surgeries use robot-controlled arms. The surgeon sits at a computer station and guides these robotic arms. Sometimes only one or two cuts are needed. It offers similar benefits as other minimally invasive techniques.
Minimally invasive surgeries often have added benefits:
| Benefit | Description |
|---|---|
| Smaller scars | Small incisions result in less noticeable scars. |
| Less pain after surgery | Smaller wounds usually hurt less. |
| Shorter recovery | Most people heal faster and go home sooner. |
Open surgery involves making a single, larger cut in the abdomen to remove the gland. The exact spot for this incision depends on several factors, including tumor size, tumor spread, and the patient’s body shape. Surgeons usually choose open techniques for bigger tumors, cancer that has reached other tissues or lymph nodes, or when scar tissue or obesity increases risks.
The choice between open and minimally invasive surgery depends on the patient’s health, the size and type of the tumor, and any previous surgeries in the area. Discussing options with a healthcare professional can help decide the best approach.
What Happens After Your Surgery
The length of hospital stay after an adrenalectomy depends on the type of operation. Most individuals who have laparoscopic or other minimally invasive forms of adrenal gland removal can leave the hospital the same day or, at most, stay one night.
People who need open adrenal gland surgery usually stay in the hospital longer, often for three to five days, depending on how the surgery went and the person’s overall health. Key points to expect after surgery:
- Hospital stays are shorter after minimally invasive surgeries.
- Recovery at home is often quicker with smaller wounds.
- Open surgery involves more discomfort, and healing takes longer.
- The care team will discuss pain management and movement plans to avoid common problems like blood clots or infection.
In some cases, the care team may monitor hormone levels after the procedure. If lymph nodes or nearby tissue were also removed, there could be extra follow-up. Regular checkups help make sure recovery is going as planned.
Surgical Outcomes
When surgeons remove an adrenal gland, they send the tissue to a laboratory. Pathologists examine the gland under a microscope and then send a report to the patient’s doctor. Afterward, the patient discusses the findings and any next steps with their healthcare provider.
Most patients have only one adrenal gland removed. In these cases, the remaining gland usually takes over the hormone production. If the remaining gland needs time to start working, some patients may need hormone replacement medication for a short period.
| Scenario | Follow-Up Need |
|---|---|
| One gland removed | Temporary medicine (if needed) |
| Both glands removed | Lifelong hormone medicine |
If surgeons remove both adrenal glands, patients require lifelong hormone replacement. Without both glands, the body cannot make certain hormones, so medicine prevents adrenal insufficiency.
