Definition
Definition
Adrenalectomy is the removal of one or both adrenal glands. There is one adrenal gland on top of each kidney. The adrenal glands make several hormones, including cortisol, aldosterone, and sex steroids. The adrenal glands also make adrenaline and noradrenaline in small amounts.
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Reasons for Procedure
Reasons for Procedure
Your adrenal gland may be removed if you have any of the following:
- Adrenal cancer
- Diseases of the adrenal gland, causing it to make too much of a hormone such as Cushing’s syndrome, Conn’s syndrome, and pheochromocytoma
- A large adrenal mass
- An adrenal mass that cannot be identified with a needle biopsy
Possible Complications
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Insufficient cortisol production
- Decreases in blood pressure
- Bleeding
- Infections in the wound, urinary tract, or lungs
- Blood clots in the legs
- Injury to nearby organs or structures
- Adverse reaction to anesthesia
Factors that may increase the risk of complications include:
- Increased age
- Obesity
- Long-standing cortisol excess
- Smoking
- Poor nutrition
- Recent or chronic illness
- Heart or lung problems
- Drinking
- Use of certain medications
- Use of illegal drugs
What to Expect
What to Expect
Prior to Procedure
Your doctor will likely do some or all of the following:
- Physical exam
- Blood tests
- Urine tests
- Imaging tests, such as abdominal ultrasound, abdominal CT scan, MRICT scan of the head, and nuclear scan
- Give certain medicines to determine why the adrenal gland is not working correctly
Let your doctor know which medications you are taking. You may be asked to stop taking or adjust the dose of certain medications.
In the days leading up to your procedure:
- Arrange for a ride home.
- Arrange for help at home.
- The night before, eat a light meal. Do not eat or drink anything after midnight.
- You may be given laxatives and/or an enema. These will clean out your intestines.
Your doctors may need to admit you to the hospital before your planned procedure if your blood pressure has not been well-controlled with medication. This will allow more aggressive treatment to stabilize your blood pressure. It will also ensure that you have enough fluid in your body to prevent blood pressure problems after the surgery is done.
Anesthesia
General anesthesia will be used. You will be asleep.
Description of the Procedure
You will likely be given IV fluids, antibiotics, and medications that depend on the condition that is being treated.
Large masses are usually removed from the front of your abdomen. This is done so that the mass can be easily removed. The rest of your abdomen can also be examined.
An incision will be made just under your rib cage or in your abdomen. The adrenal gland will be carefully separated from the kidney. The gland will then be removed through the incision. The incision will be closed with either stitches or staples. It will be covered with a sterile dressing.
The doctor may choose to place a tiny, flexible tube into the area where the gland was removed. This tube will drain any fluids that may build up after surgery. It will be removed within one week after your operation.
Immediately After Procedure
The adrenal gland(s) will be sent to a lab to be examined. You will be sent to a recovery room. There, you will be monitored for any reactions to the surgery or anesthesia.
How Long Will It Take?
1½ hours-3½ hours
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
4-5 days
Postoperative Care
At the Hospital
The staff will monitor your breathing, pulse, and temperature. You may also need:
- Pain and anti-nausea medications.
- A nasogastric tube through your nose and into your stomach. It will drain fluids and stomach acid. You will not be able to eat or drink until this is removed and you are no longer nauseated. In this case, you will continue to receive IV fluids. When you begin eating, you may need to eat a lighter, blander diet than usual.
- Compression stockings to decrease the possibility of blood clots forming in your legs.
- Steroid medications immediately after surgery. The dose will be gradually reduced.
At Home
Recovery time may be as long as 4-6 weeks. To help ensure a smooth recovery:
- You will need to be carefully monitored to see that your body is producing the right amount of steroids and hormones. Monitoring also verifies that you are taking the correct dose of steroid or homone replacement medication.
- You may be asked to weigh yourself daily and report any weight gain of two or more pounds over 24 hours. Such weight gain may indicate that you are retaining fluid. You may be asked to monitor your blood pressure regularly at home.
- Try to increase your physical activity according to your doctor’s instructions. This will help you avoid respiratory complications from the general anesthesia and improve the recovery of your digestive system.
Call Your Doctor
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Persistent nausea and/or vomiting
- Pain that you cannot control with the medications you’ve been given
- Pain, burning, urgency, or frequency of urination
- Blood in the urine
- Cough, shortness of breath, or chest pain
- Pain and/or swelling in your feet, calves, or legs
- Headaches
- Lightheadedness
- New or worsening symptoms
If you think you have an emergency, call for medical help right away.
RESOURCES:
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov
CANADIAN RESOURCES:
Kidney Foundation of Canada: British Columbia Branch http://www.kidney.bc.ca
References:
Gallagher SF, Wahi M, et al. Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1,816 adreanlectomies. Surgery. 2007;142:1011-1021.
Hanssen WE, Kuhry E, et al. Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg. 2006;93:715-719.
Jossart GH, Burpee SE, et al. Surgery of the adrenal glands. Endocrinol Metab Clin North Am. 2000;29:57-68.
Munver R, Del Pizzo JJ, et al. Adrenal-preserving minimally invasive surgery: The role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep. 2003;4:87-92.
Pamaby CN. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc. 2008;22:617-621.
Thompson SK, Hayman AV, et al. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: A 10-year experience. Ann Surg. 2007;245:790-794.
Last Updated: 3/18/2013