Adrenalectomy is the surgical removal of one or both adrenal glands. The adrenal glands are paired endocrine glands—one located above each kidney—that produce hormones such as epinephrine, norepinephrine, androgens, estrogens, aldosterone, and cortisol. Adrenalectomy is usually performed by conventional (open) surgery; however, in selected patients, surgeons may use laparoscopy . With laparoscopy, adrenalectomy can be accomplished through four very small incisions.
Adrenalectomy is usually advised for patients with tumors of the adrenal glands. Adrenal gland tumors may be malignant or benign, but all typically excrete excessive amounts of one or more hormones. When malignant, they
Neuroblastoma is one of the few cancer types known to secrete hormones. It occurs most often in children, and it is the third most common cancer that occurs in children. In the united States, approximately 7.5% of the childhood cancers diagnosed in 2001 were neuroblastomas, affecting one in 80,000 to 100,000 children. Close to 50% of cases of neuroblastoma occur in children younger than two years old. The disease is sometimes present at birth, but is usually not noticed until later. Approximately one-third of neuroblastomas start in the adrenal glands. According to some reports, African-American children develop the disease at a slightly higher rate than Caucasian children (8.7 per million compared to 8.0 per million cases diagnosed).
The surgeon may operate from any of four directions, depending on the exact problem and the patient's body type.
In the anterior approach, the surgeon cuts into the abdominal wall. Usually the incision will be horizontal, just under the rib cage. If the surgeon intends to operate on only one of the adrenal glands, the incision will run under just the right or the left side of the rib cage. Sometimes a vertical incision in the middle of the abdomen provides a better approach, especially if both adrenal glands are involved.
In the posterior approach, the surgeon cuts into the back, just beneath the rib cage. If both glands are to be removed, an incision is made on each side of the body. This approach is the most direct route to the adrenal glands, but it does not provide quite as clear a view of the surrounding structures as the anterior approach.
In the flank approach, the surgeon cuts into the patient's side. This is particularly useful in massively obese patients. If both glands need to be removed, the surgeon must remove one gland, repair the surgical wound, turn the patient onto the other side, and repeat the entire process.
The last approach involves an incision into the chest cavity, either with or without part of the incision into the abdominal cavity. It is used when the surgeon anticipates a very large tumor, or if the surgeon needs to examine or remove nearby structures as well.
This technique does not require the surgeon to open the body cavity. Instead, four small incisions (about 0.5 in [1.27 cm] diameter each) are made into a patient's flank, just under the rib cage. A laparoscope enabling the surgeon to visualize the inside of the abdominal cavity on a television monitor is placed through one of the incisions. The other incisions are for tubes that carry miniaturized versions of surgical tools. These tools are designed to be operated by manipulations that the surgeon makes outside the body.
Most aspects of preparation are the same as in other major operations. In addition, hormone imbalances are often a major challenge. Whenever possible, physicians will try to correct hormone imbalances through medication in the days or weeks before surgery. Adrenal tumors may cause other problems such as hypertension or inadequate potassium in the blood, and these problems also should be resolved if possible before surgery is performed. Therefore, a patient may take specific medicines for days or weeks before surgery.
Most adrenal tumors can be imaged very well with a CT scan or MRI, and benign tumors tend to look different on these tests than do cancerous tumors. Surgeons may order a CT scan, MRI, or scintigraphy (viewing of the location of a tiny amount of radioactive agent) to help locate exactly where the tumor is located.
The day before surgery, patients will probably have an enema to clear the bowels. In patients with lung problems or clotting problems, physicians may advise special preparations.
Patients stay in the hospital for various lengths of time after adrenalectomy. The longest hospital stays are required for open surgery using an anterior approach; hospital stays of about three days are indicated for open surgery using the posterior approach or for laparoscopic adrenalectomy.
The special concern after adrenalectomy is the patient's hormone balance. There may be several sets of required lab tests to define hormone problems and monitor the results of drug treatment. In addition, blood pressure problems and infections are more common after removal of certain types of adrenal tumors.
As with most open surgery, surgeons are also concerned about blood clots forming in the legs and traveling to the lungs (venous thromboembolism), bowel problems, and postoperative pain. With laparoscopic adrenalectomy, these problems are somewhat less prevalent, but they are still present.
The risks of adrenalectomy include major hormone imbalances, caused by the underlying disease, the surgery, or both. These can include problems with healing, blood pressure fluctuations, and other metabolic problems.
Other risks are typical of many operations. These include:
The outcome of an adrenalectomy depends on the condition for which it was performed. For example, in the case of hyperaldosteronism, the surgical removal of the adrenal glands provides excellent results, with the majority of patients being cured. In the case of patients diagnosed with pheochromocytoma, long-term cures are rare in cases of malignant pheochromocytomas. In cases of metastatic disease, five-year survival rates as high as 36% have been reported.
There is wide agreement that laparoscopic approaches decrease operative morbidity. The laparoscopic approach is commonly used to treat smaller adrenal tumors. At many laparoscopic centers, the laparoscopic adrenalectomy has become the standard practice. Several centers recommend a particular approach or laparoscopic method, but regardless of which approach is preferred, the cure and morbidity rates are similar for laparoscopic and open adrenalectomy (in the case of small tumors). No method is suitable for all patients. In general, selecting the approach based on patient and tumor characteristics while considering the familiarity of the surgeon yields the best results.
Alternatives to adrenalectomy depend on the medical condition underlying the decision to perform the surgery. In some cases, drug therapy may be considered as an alternative when the condition being treated in benign.
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Richard H. Lampert Monique Laberge, Ph.D.
Adrenalectomies are performed by general or endocrine surgeons. Surgeons work closely with their medical colleagues (endocrinologists) who are often the doctors who are responsible for both the initial diagnosis and investigation of endocrine disorders. Endocrinologists may also be involved in long-term follow-up care after the adrenalectomy. Endocrine surgeons also work with nuclear medicine physicians, radiologists, pathologists, geneticists, and anesthetists to provide the best possible patient care.
removal of the left adrenal gland. After two months my bloodpresser is still high!
I also have high cortisol levels.
Is this common?
Are there standard solutions for this?
I have a appointment coming up with a Hemotologist in a few days.
Do you have an answer?
removal of the left adrenal gland?
Kat
UK
I am having my right hand adrenal tumor 7cm removed 8th August I beleive they are going to remove key hole I would like to know what are the chances of this changing to open surgery? How often would this happen?
P.S. a lot of doctors do not pay attention to scar treatment. I have numerous scars on my body and I can tell you from experience you must treat your scars or they will harden and stay red. I highly recommend “Palmer’s Coconut Butter Formula with vitamin E” in the tub not the lotion. You can get it at Walmart or any drug store. I use a q-tip and scoop out the butter and rub it on my scar 1-3 times a day (when you get up and go to bed is fine). It helps keep your scar soft and pliable and helps fade the color of the scar. It is very beneficial for all the scars I have. The coconut butter softens it and the vitamin e will help it fade and heal it.
All my tests were normal (though I was being treated for thyroid and adrenal dysfunction, so it might have masked any problems). I normally have low blood pressure, so it did not register as being high even though it was high for me. The CAT scan, the blood tests, the urine test, and the ultrasound were all normal. I went to a gastroenterologist and he could not find anything wrong with me and suggested I had psychological problems since all the tests were normal. I finally had an endoscopy that found the adrenal lesion on my left adrenal gland that was 25mmx28mm. The gastroenterologist didn’t think this was significant and referred me to a neurologist, because of the blurred vision (he didn’t think my whole list of symptoms was significant). I even pointed out the results of the endoscopy that showed the adrenal gland cyst and he did not think it was significant nor did he think it was the cause of my symptoms. So he was ready to believe I was hormonal and depressed, but would not believe the adrenal gland cyst had anything to do with it. Really!?!?!I did my own research and found the adrenal gland cysts could cause every single symptom I was having including blurred vision. I saw my regular doctor and asked to see an experienced endocrinologist. There are very few doctors that specialize in adrenal glands since these type cysts and tumors are so rare. A friend of mine referred me to a hospital near him in Missouri that does specialize in adrenal glands and tumors. I have asked to be referred there so I can see an experienced doctor. I do not want a regular endocrinologist to see me, but think it is best to seek out someone who deals with this on a regular basis. The adrenal glands are the motor that runs all the major systems in the body and after surgery or treatment you will need to be regulated and monitored for a while until all your systems are regulated again.
Be your own advocate. I highly suggest people avoid blindly listening to doctors, particularly if you feel they are not taking you seriously. I have always said, no matter how intelligent a doctor is, no matter how educated a doctor is, no matter how experienced a doctor is, they will NEVER be an expert on my body. I am. Use the internet and books to check things out. Make a list of every single symptom you are having whether you think it is relevant or not. Make a list of every test you take and every doctor you see. I put all of these lists on the computer so I can easily add to them and can copy them when I need to. Get copies of every single test result and read them yourself. It is amazing what things show up in testing that doctors overlook or refuse to consider significant. I just know without a doubt that the adrenal gland cyst is what is causing my symptoms. I am making sure I know everything I possibly can before agreeing to treatment or before being referred to another “specialist”. Women in particular need to educate themselves on how the thyroid and adrenal glands affect their hormones and ability to function. A good resource for information about the adrenal gland is “Adrenal Fatigue: The 21st century syndrome” by James Wilson, and “Living Well with Hypothyroidism” by Mary Shomon. Every woman who has been told “you are just hormonal or depressed” needs to read these books, though men can benefit as well. Stress affects the way your adrenal glands work which in turn affects all your other systems. It can be psychological stress, emotional stress, intellectual stress, or physical stress, but whatever the kind of stress it is it will affect the adrenal glands. I found my initial symptoms were not very severe and were somewhat vague. I didn’t know what to tell my doctors, but I knew something odd and different was going on with my body. Doctors like to blame everything on the medication you are taking, your hormonal state, you emotional state, your eating habits, your work habits, etc., but you know your body well enough to know it is not any of those things. As time went on, my symptoms became more severe and then more symptoms appeared. I am glad to read about other’s experiences before I attempt surgery. The more informed I have, the better decision I can make.
My bp dropped drastically post op, and settled within 5 days to 95/65. My potassium level also stabilised in this time. I do not take any medication now.
Being young, fit, slim and healthy, I had no idea how badly my body would react to the surgery. I do not wish to alarm anybody, but it seems to be the case that the slimmer you are the harder you will bounce back. The surgery went well, but I changed from being 100% overactive to 5% function post op. For the first 4 days I could not talk easily due to weak lungs, my walking was pure comedy as I was shuffling and was bent double like a pensioner, which was quite amusing in my local drs surgery when visited for a blood test 4 days post op, I was the youngest person there! I couldn't lay flat or sit upright for more than 10 minutes at a time for the first 2 weeks. My pain was controlled by painkillers quite well. Every day I would rest on the sofa and was very lucky to stay with family who helped with my recovery. After 4 weeks I could slowly walk for a maximum of 30 minutes in one go, but would spend many hours afterwards resting. I tried to go back to work after 7 weeks, I work outside so this was far more challenging than sitting at a desk, and could manage mornings but would have to rest everyday once I got home.
It has been nearly 5 months post op now, and I am finally starting to feel better. My blood pressure would fluctuate from the lowest reading of 75/49 - 100/70 over the first few months. When it was very low I was numb with fatigue, but gradually it has increased. I still get very tired and most of the time I have bags under my eyes. I have circulation problems now but I can see this makes sense after such a change in bp. I have bought warm boots and gloves ready for the winter months ahead. I have met a few people who have struggled after surgery, but nobody mentioned this might be the case beforehand. I now realised any surgery is a huge invasion for the body and many people say it is 6-12 months before they feel normal again. I also have vertical ridges on all of my fingernails which is what brought me onto this site today. I hope my experience will be useful to anyone who is going through the same condition, and most importantly of all, I AM starting to feel better.
Thank you for not making me not feeling alone I am a 53 year old male with malignant hypertension. I have been on blood pressure since I was 16 years old. Currently 18 BP pills x4 a day no luck my endocrinologist is ordering a MIBG scan but more than likely she is making a referral for surgery and a open exploratory laparotomy all test except 24 urine and blood show positive but I can not have an MRI due to metal in my back. Has anyone seen this before and thank you once again.
CT scan detects left adrenal gland adenomas measuring size 0.9 and 1 cm in left adrenal gland..Huge side effects facing like very hard to walk..Always diziness..Always Restlessness..fainting situation..Hard to see and concentration..Pls help me...Any advice...I am from Kolkata...My doctor saying ur tumor not secrets any hormone..
My question then if my tumor is not functioning then why I am facing these so many side effects??
Any valuable advice is required.
Mr.datta here