What are the other Names for the Procedure?
What is the Adrenal Gland Removal surgical procedure?
- Adrenal Gland Removal or Adrenalectomy is the surgical removal of one or both the adrenal glands.
The adrenal glands are important for the normal physiologic functioning of the body. The glands are composed of two functionally distinct hormone units; the adrenal cortex and the medulla, which are placed within a single capsule. The adrenal cortex is divided into three functional zones:
- Zona glomerulosa, which secretes aldosterone that regulates sodium and potassium balance
- Zona fasciculate, which secretes steroids (cortisol)
- Zona reticularis, which secretes sex steroids (primarily androgens – male hormones)
The adrenal medulla synthesizes and secretes catecholamines (noradrenaline and adrenaline), which modulate the body's response to stress.
Surgical removal of the adrenal gland is performed either due to non-functioning adrenal gland pathology or functioning adrenal gland pathology.
- Functioning adrenal gland pathology are those conditions where adrenal gland produces excess hormones or catecholamines
- Non-functioning adrenal gland pathology includes tumors that do not produce any hormones (incidentaloma) and adrenal cancers
What part of the Body does the Procedure involve?
An Adrenal Gland Removal procedure involves the adrenal gland and kidney.
Why is the Adrenal Gland Removal surgical procedure Performed?
Adrenocortical diseases are classified on the basis of whether there is a hormone deficiency or excess production of hormone. Disorders of adrenal hormone deficiency (e.g., primary adrenal insufficiency, also known as Addison’s disease) are not treated surgically. In contrast, many disorders of adrenal hormone excess do require surgical intervention, including:
- Cushing’s syndrome; a disorder caused by high level of secretion of the hormone cortisol by a tumor of the adrenal cortex
- Conn’s Syndrome: a condition where tumor of the adrenal cortex causes excessive secretion of hormone aldosterone leading to various disorders
- Androgen secreting tumor of the adrenal cortex (this is less common disorder though)
- Pheocromocytoma; a tumor affecting the adrenal medulla or inner center of the adrenal glands
- Adrenal cancer
What are some Alternative Choices for the Procedure?
If the patient suffers from adrenal cancer, an Adrenalectomy is a considered a good and assured treatment option
- In some cases medical treatment is also considered, if surgical removal of the adrenal glands is difficult
- In situations where non-functioning tumors of the adrenal gland are detected incidentally (incidentaloma), periodic imaging and biochemical blood testing may be performed to check, if there is an increase in size, or if it is turning to a functioning tumor. In such cases, surgery is indicated
What are the Recent Advances in the Procedure?
The recent advancement in Adrenalectomy is in the use of laparoscopic technique. However, laparoscopy is a good option when the tumors are small and uncomplicated. Also, the rates of recovery with laparoscopic techniques are faster, when compared to an open surgery for adrenal gland removal.
What is the Cost of performing the Adrenal Gland Removal surgical procedure?
The cost of Adrenal Gland Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Adrenal Gland Removal and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one
What are some Helpful Resources?
Prior to Adrenal Gland Removal surgical procedure:
How is the Adrenal Gland Removal surgical procedure Performed?
- In an Open Adrenalectomy, an incision is made on the patient’s torso and below the rib cage
- Depending on the patient’s body type and the problem requiring the surgery, the surgeon may make an incision in the abdomen, back, or the sides
- Next, the surgeon may move through the muscles, tissues, and abdominal organs to locate the adrenal gland, which is placed just on the upper aspect of the kidneys
- The adrenal glands are then isolated, severed, and removed
- The organs, muscles, and tissues are placed back in position and the skin is closed with sutures, and the surgical wound is bandaged
Laparoscopic or Minimally Invasive Adrenalectomy:
- In a Laparoscopic or Minimally Invasive Adrenalectomy, the surgeon makes tiny incisions to pass a camera and other instruments inside the abdomen
- The adrenal gland is located, the surgeon then divides it and removes the gland through one of the incisions
Where is the Procedure Performed?
An Adrenal Gland Removal procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged, as per the instruction of the physician.
Who Performs the Procedure?
The procedure is performed by a general surgeon along with an anesthesiologist
How long will the Procedure take?
An Adrenalectomy may take anywhere between 1-3 hours depending on the condition of the glands and patient’s body type.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
The physician/surgeon may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
- Some of the medication may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
- Sometimes blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevents them from undergoing the procedure
- The surgeon may ask for both routine and specific tests to determine the blood hormone levels and specific blood bio-chemical counts. In case of an imbalance, the surgeon will prescribe oral medications to correct the problem prior to the surgery
- The patient must avoid smoking or use of nicotine as it slows down the healing process of the body
- If the patient suffers from hypertension or any lung ailments, the condition must be treated prior to surgery
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
A physician will request your consent for Adrenal Gland Removal procedure using an Informed Consent Form.
What is the Consent Process before the Procedure?
A physician will request your consent for Adrenal Gland Removal procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Adrenal Gland Removal surgical procedure?
Before an Adrenal Gland Removal procedure, the patient has to undergo certain tests such as:
- Blood tests.
- CT Scan of the abdomen and pelvis
- MRI of the abdomen and pelvis
- X-ray of kidneys
- Ultrasound of kidneys
- Urine analysis
- In few cases, depending on the patient health status, the surgeon may ask for specific tests.
The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do all or a few of the above tests.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is an Adrenal Gland Removal (Adrenalectomy)?
- Why is this procedure necessary?
- What does the procedure involve?
- Where is the procedure performed?
- How will this procedure help?
- How soon should I get it done? Is there an emergency?
- How long will it take to recover? When can I resume normal work?
- Are there any other alternatives to Adrenalectomy?
- Will oral medications solve the problem?
- What are the risks while performing the procedure?
- What are the complications that might take place while recovering?
- Will removing the adrenal glands affect the hormonal balance of the body?
- Would I need to take oral medication to substitute for the hormones produced by the glands?
- Are these medications required to be taken for life, after the procedure?
- Are there any lifestyle restrictions or modifications required, after the procedure is performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
- Who are the medical personnel involved in this procedure?
- How many procedure have you (the physician) performed?
During the Adrenal Gland Removal surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia is administered during the procedure.
How much Blood will you lose, during the Procedure?
Open Adrenalectomy is an invasive surgery; hence there may be some blood loss during the procedure. However, blood loss is usually not significant, unless there is any complication during the surgery.
What are the possible Risks and Complications during the Adrenal Gland Removal surgical procedure?
The possible risks and complications that may arise during a surgery are:
- Excessive bleeding
- Damage to adjacent organs or tissue
- Surgical infection
- Anesthetic complication
- Fluctuation in blood pressure (particularly in cases of pheochromocytoma)
What Post-Operative Care is needed at the Healthcare Facility after the Adrenal Gland Removal surgical procedure?
No particular post-operative care is required unless complications arise.
After the Adrenal Gland Removal surgical procedure:
What are the possible Risks and Complications after the Adrenal Gland Removal surgical procedure?
Post Adrenal Gland Removal (Adrenalectomy) surgery, the following complications may arise:
- Adrenal hormonal shortage
- Surgical wound infection
- Fluid retention
What is the Prognosis after the Surgery?
The prognosis for an Adrenal Removal surgery depends on the reason for undergoing the surgery. In any case, if both the adrenal glands have been removed, the patient will need life-long hormone replacement.
Cancerous adrenal glands with large tumors and in cases, where the malignancy has spread to the neighboring organs, chances of complete recovery remain rare.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain in and around the surgical wound
- Swelling and redness
- Drainage and bleeding from the wound
- Signs of infection
- Sudden increase in weight
- If any new symptoms are observed
What Post-Operative Care is needed at Home after the Adrenal Gland Removal surgical procedure?
At home, the following post-operative care is recommended, after Adrenal Gland Removal procedure:
- Keep the surgical wound clean and dry
- Avoid bathing for 48 hours post-surgery
- While bathing use a mild and unscented soap to wash the wound
- Take stool softeners to avoid constipation
- Avoid any strenuous activity for 3 weeks
- Complete the course of medication prescribed by the physician
- Keep a check on body weight
- Avoid sex till complete healing is achieved, or follow the physician’s advise
How long does it normally take to fully recover, from the Procedure?
It may take anywhere between 5-6 weeks to recover completely, after the procedure is performed.
What happens to tissue (if any), taken out during the Procedure?
The tissue is sent for further examination and later disposed, as per standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Adrenal Gland Removal surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The hospital
- A general surgeon
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before an Adrenal Gland Removal (Adrenalectomy) surgical procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA