Adrenalectomy is a surgery to remove one or both of your adrenal glands.
The two adrenal glands are located on top of each kidney. These glands secrete hormones that help regulate growth, development, metabolism, sexual function, blood sugar, blood pressure, etc. The adrenal glands also help your body regulate the immune system, respond to stress (fight/flight reaction) and other vital functions.
What You Need to Know About Adrenalectomy
Adrenalectomy is a surgical procedure to remove either one or both adrenal glands. Bilateral adrenalectomy is removing both adrenal glands, while unilateral adrenalectomy is the removal of one adrenal gland.
The surgeons perform this surgery to remove tumors (abnormal growth of cells) of the adrenal glands. The adrenal tumor could be a benign tumor (non-cancerous) or a malignant tumor (cancerous).
Depending on the type of tumor and your health condition, there are two types of surgical procedures to remove the adrenal tumor- minimally invasive (laparoscopic surgery) or traditional open surgery.
In laparoscopic surgery, the surgeon removes the tumor through smaller incisions made in your body. While with a cancerous tumor, the surgeon performs traditional open surgery.
When is an Adrenalectomy done?
Patients with adrenal gland problems may have a variety of symptoms related to excess production of hormone by the abnormal gland. Adrenal tumours linked 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.
- 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.
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.
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Based on the severity of your symptoms, your doctor may order tests like:
- Blood tests, including a test to measure cortisol levels in your body. Cortisol is the steroid hormone released by your adrenal glands.
- Urine test
- Biopsy of the tumour to determine whether it is benign/ malignant
- Magnetic resonance imaging (MRI)
- Computed tomography (CT) scan
- Adrenal vein sampling
After diagnosis, the doctor will refer you to an endocrinologist who will evaluate your condition thoroughly. Depending on the tumor (benign or malignant), its size, and whether it is producing excess hormones, the endocrinologist will discuss the further course of treatment.
If it is a non-functioning benign tumor, you will not need any treatment. Your doctor will just monitor the tumor during future visits. If the benign tumor is functioning, causing a hormone imbalance in your body by producing excess hormones, the doctor will prescribe medication or surgery. For symptomatic relief, your doctor may prescribe medications instead of surgery. These medications will lower hormone levels.
You will need to undergo Adrenalectomy for large (over 4 to 5 centimetres) malignant tumours.
Types of Adrenalectomy
Your doctor will explain the available treatment options and discuss the best approach.
Your surgeon may perform open surgery if the tumor is large or cancerous. The surgeon will make an open cut on the abdomen to remove the affected adrenal gland.
This is a minimally invasive procedure where the surgeon makes a few small incisions on the body. This procedure uses a laparoscope along with surgical equipment. A laparoscope is a thin tube with a tiny video camera that enables the surgeon to see inside your body. The camera attached to the laparoscope helps the surgeon get a magnified 3-D view of the surgery site on a monitor.
Apart from being minimally invasive, laparoscopic Adrenalectomy has the following benefits:
- Minimal scarring
- Less blood loss during surgery
- Less painful
- Shorter hospital stay
- Quick recovery
Another procedure is a Robot-Assisted Adrenalectomy. In this approach, the surgeon performs the surgery through minor cuts (incisions) using computer-controlled systems and a robot arm with a camera and instruments attached to it. Robot-assisted surgery offers more precision and accuracy than a laparoscopic procedure.
In both cases, the surgeon makes incisions either on the back (posterior retroperitoneoscopic Adrenalectomy or PRA) or front (laparoscopic Adrenalectomy) of the abdomen.
Cryoablation is a procedure where the surgeons insert a probe that freezes and breaks up the adrenal tumors using computerized tomography imaging (CT imaging). Surgeons use this as an option for small tumors and high-risk surgeries.
How an Adrenalectomy may Benefit You
Adrenalectomy is helpful in patients who have adrenal cancer. It is the primary treatment for benign or malignant adrenal tumors. This surgical procedure helps correct hormonal imbalance in the body, which is one of the major side effects of adrenal tumors. With benefits like smaller incisions, low risk of hernias, and reduced postoperative pain, laparoscopic adrenalectomy will help you recover faster.
Complications and Associated Risk Factors of Adrenalectomy
As with any major surgery, a few complications like infection, bleeding, and damage to nearby organs, etc., may occur. Your doctor will monitor you for:
- Any bleeding
- Blood clots
- Bowel disorders
- Damage to nearby organs
- Reactions to anesthesia
- Any Infection
- Poor wound healing, etc.
These complications are very rare and are more likely with open adrenalectomy than laparoscopic adrenalectomy.
The side effects of adrenalectomy can be hormonal imbalances because of the removal of the adrenal gland. These hormonal imbalances affect the body’s essential functions like metabolism, blood sugar regulation, and blood pressure control.
Adrenal tumors affect the hormonal balance in the body, which may lead to several health complications. These complications can be life-threatening. Undergoing adrenalectomy to remove the adrenal tumor will help you feel better in a few weeks. You are more likely to recover quickly with laparoscopic adrenalectomy or robotic adrenalectomy.
You should consult a doctor and seek treatment if you or any member of your family has any symptoms related to adrenal tumors.
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Frequently Asked Questions (FAQs)
What are the side effects of having my adrenal gland removed?
After Adrenalectomy, which is the surgical removal of one or both of your adrenal glands, your body may undergo some changes. These include hormonal imbalance and elevated levels of serum potassium and cortisol levels. You may notice a few other symptoms like fatigue, low blood pressure, infections, etc.
What type of doctor removes adrenal tumors?
For Adrenalectomy, you need to see a surgical endocrinologist. A surgical endocrinologist specializes in diagnosing and treating adrenal gland tumors through surgery.