Part UT Health San Antonio

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.

Adrenal Glands
Adrenal Kidney

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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, which can occur with Cushing syndrome, Conn syndrome, or pheochromocytoma
  • A large adrenal mass
  • An adrenal mass that cannot be identified with a needle biopsy

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

Prior to Procedure

Your doctor will likely do some or all of the following:

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 or an enema to 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 1 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:

  • Medications to control pain and nausea.
  • A 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.
  • Steroid medications immediately after surgery. The dose will be gradually reduced.

Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision

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 2 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 if any of these occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea /or vomiting
  • Pain that you cannot control with the medications you were given
  • Pain, burning, urgency, or frequency of urination
  • Blood in the urine
  • Cough, shortness of breath, or chest pain
  • Pain or swelling in your feet, calves, or legs
  • Headaches
  • Lightheadedness
  • New or worsening symptoms

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

Urology Care Foundation
http://www.urologyhealth.org

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

The Kidney Foundation of Canada
https://www.kidney.ca

REFERENCES:

Agha A, von Breitenbuch P, Gahli N, Piso P, Schlitt HJ. Retroperitonenscopic adrenalectomy: lateral versus dorsal approach. J Surg Oncol. 2008;97(1):90-93.

Gallagher SF, Wahi M, Haines KL, et al. Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1,816 adreanlectomies. Surgery. 2007;142(6):1011-1021.

Hanssen WE, Kuhry E, Casseres YA, de Herder WW, Steyerberg EW, Bonjer HJ. Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg. 2006;93(6):715-719.

Jossart GH, Burpee SE, Gagner M. Surgery of the adrenal glands. Endocrinol Metab Clin North Am. 2000;29(1):57-68.

Munver R, Del Pizzo JJ, Sosa RE. Adrenal-preserving minimally invasive surgery: The role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep. 2003;4(1):87-92.

Pamaby CN, Chong PS, Chisholm L, Farrow J, Connell JM, O'Dwyer PJ. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc. 2008;22(3):617-621.

Thompson SK, Hayman AV, Ludlam WH, Deveney CW, Loriaux DL, Sheppard BC. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: A 10-year experience. Ann Surg. 2007;245(5):790-794.

Last reviewed March 2018 by EBSCO Medical Review Board Marcin Chwistek, MD  Last Updated: 3/18/2013