The adrenal glands, two small, triangular-shaped endocrine glands, are situated on top of each kidney. These glands produce a variety of hormones, including cortisol, aldosterone, and adrenaline, which play roles in regulating metabolism, blood pressure, the body’s stress response, and immune system functions.
Why Adrenal Surgery is Performed
Adrenalectomy is commonly recommended to address specific conditions affecting these glands. A primary reason for surgery is the presence of tumors, most of which are benign (non-cancerous). Non-cancerous tumors may require removal if they become large, typically exceeding 4 to 6 centimeters, or if they produce an excess of hormones.
Conditions that lead to hormone overproduction include pheochromocytoma, which causes excessive adrenaline-type hormones leading to high blood pressure, headaches, sweating, and a rapid heart rate. Conn’s syndrome (aldosteronoma), where too much aldosterone results in high blood pressure and low potassium levels, is another. Cushing’s syndrome, characterized by an overproduction of cortisol, may also require surgery, particularly if caused by an adrenal tumor. Cancer that originates in the adrenal glands is rare, but cancer that has spread to the adrenal glands from other parts of the body, such as the lung or kidney, may also require surgery.
Understanding the Risks
Adrenalectomy, like any surgical procedure, carries risks and complications. General surgical risks include bleeding, infection at the surgical site, and adverse reactions to anesthesia. Other general complications can involve blood clots, which may lead to serious issues like pneumonia. Wound healing problems or the formation of a hernia at the incision site are also possible.
Specific risks related to adrenal gland surgery involve injury to nearby organs during the procedure. The adrenal glands are situated close to organs like the kidney, spleen, pancreas, liver, and major blood vessels. Although uncommon, damage to these surrounding organs can occur, with the spleen being the most frequently injured organ during left-sided adrenalectomy, sometimes requiring its removal. Post-surgery, patients may experience changes in blood pressure, either too high or too low, and hormonal imbalances.
A specific risk is adrenal insufficiency, a condition where the body does not produce enough steroid hormones after surgery. If only one adrenal gland is removed, the remaining gland compensates over time by increasing hormone production. However, for individuals with Cushing’s syndrome, the remaining gland may not function properly due to prolonged suppression, increasing the risk of adrenal insufficiency. If both adrenal glands are removed, lifelong hormone replacement therapy becomes necessary.
Minimizing Surgical Risks
To reduce the risks of adrenal gland surgery, a thorough pre-operative evaluation is conducted. This assessment includes imaging studies like CT scans or MRIs, hormone level testing in blood and urine, and a cardiac assessment to optimize patient health for surgery. Specific preparations, such as blood pressure monitoring and medication adjustments, may be required, especially for those with hormone-producing tumors.
The experience of the surgical team plays a role in minimizing complications. Advanced surgical techniques have also improved safety and recovery. Minimally invasive approaches, such as laparoscopic adrenalectomy, are now the preferred method. This involves making several small incisions, through which a camera and specialized instruments are inserted.
Laparoscopic surgery offers benefits such as smaller scars, less pain, reduced blood loss, shorter hospital stays, and a quicker return to normal activities compared to traditional open surgery. Open surgery, which involves a larger incision, is reserved for very large tumors, those suspected of being cancerous, or cases with extensive scar tissue from previous operations. Post-operative monitoring and care, including pain management and wound care, are also important for risk reduction.
Recovery and Outlook
Following adrenal gland surgery, patients can expect a recovery period that varies depending on the surgical approach. Those who undergo minimally invasive laparoscopic procedures often have a shorter hospital stay. Recovery from laparoscopic surgery takes one to three weeks before returning to full activity. Open surgery requires a longer hospital stay, with a recovery period that can extend to two to four weeks or more.
Immediate post-operative experiences may include mild to moderate pain, which can be managed with prescribed medication, and possibly nausea or vomiting. Patients are encouraged to start light activities like walking soon after surgery to aid recovery. However, strenuous activities, heavy lifting, or movements that strain the abdominal muscles are restricted for several weeks to prevent complications like incisional hernias.
The long-term outlook after adrenalectomy is positive, with the surgery resolving the underlying condition. If only one adrenal gland is removed, the remaining gland compensates for the loss of hormone production, and lifelong hormone replacement may not be necessary. However, if both adrenal glands are removed, lifelong hormone replacement therapy is required to replace hormones like cortisol and aldosterone. Regular monitoring of hormone levels and blood pressure is important to adjust medication dosages.