Adrenalectomy

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

An operation to remove one or both of the adrenal glands. These glands are located on top of each kidney

Parts of the Body Involved

Adrenal gland(s)

Reasons for Procedure

• Malignant adrenal tumors
• Benign adrenal tumors, such as pheochromocytoma
• Enlargement or abnormalities of the adrenal gland, resulting in symptoms and complications due to excess hormone production (such as Cushing's syndrome)

Risk Factors for Complications during the Procedure

• Age: 60 or older
• Obesity
• Smoking
• Excess stress
• Malnutrition
• Recent or chronic illness
• Heart or lung problems
• Alcoholism
• Use of certain medications, including blood pressure pills, muscle relaxants, tranquilizers, sleeping pills, insulin, steroids, sedatives, and hypnotic agents
• Use of street drugs, including LSD, hallucinogens, marijuana, and cocaine

What to Expect

Prior to Procedure

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

• Physical exam
• Blood tests
• Urine tests
• Abdominal ultrasound – a test that uses sound waves to find specific areas in the abdomen
• CT scan – a type of x-ray that uses a computer to make pictures of the kidneys and/or adrenal glands
• MRI scan – a test that uses magnetic waves to make pictures of the kidneys and/or adrenal glands
• CT scan or MRI scan of the head to examine the pituitary gland (this gland affects the functioning of the adrenal glands)
• If your doctor diagnoses a hormone imbalance, high blood pressure, or low blood potassium, you may be given corrective medications in the weeks or months prior to your operation

In the days leading up to your procedure:

• Arrange for a ride to and from the procedure
• Arrange for help at home after returning from the hospital
• The night before, eat a light meal and do not eat or drink anything after midnight
• You may be given laxatives and/or an enema to clean out your intestines

During Procedure:

• IV fluids
• Sedation
• Anesthesia
• Breathing tube
• You may require a tube through your nose and into your stomach to remove accumulated stomach acid and fluids
• You may require a catheter in your bladder until a few hours after the operation is completed

Anesthesia - General

Description of the Procedure - There are two main types of adrenalectomy:

Classic open abdominal adrenalectomy: The adrenal glands can be removed from the front, back, or side through a horizontal incision just under the rib cage, or through a vertical incision in the abdomen (done when both adrenal glands need to be removed and/or examined). The adrenal gland is carefully separated from the kidney and removed. The surrounding area and/or the other adrenal gland and kidney are examined.

The surgeon may choose to place a tiny, flexible tube into the area where the adrenal gland was removed. This tube will exit from your abdomen into a little bulb, in order to drain any fluids that may accumulate during the first few days after surgery. The tube will be removed within one week after your operation. The incision is closed with either stitches or staples, and then covered with a sterile dressing.

Laparoscopic adrenalectomy: The surgeon makes several tiny incisions or punctures in the abdomen. A tiny camera is passed through one of these openings, allowing the procedure to be monitored on a video screen in the operating room. Other surgical instruments are passed into the abdomen through the other incisions, and are used to separate the adrenal gland from the kidney and to pull the removed gland back out through one of the incisions. The incisions are often small enough to be closed with just a couple of stitches or staples, and covered with small bandages.

After Procedure - The adrenal gland(s) are examined by a pathologist

How Long Will It Take? Between 1 1/2 hours and 3 1/2 hours

Will It Hurt? Anesthesia prevents pain during surgery. Patients typically experience pain or soreness during recovery, but receive pain medication to relieve the discomfort. However, the advantage of the laparoscopic adrenalectomy is the lack of a large abdominal incision. Therefore, patients who undergo laparoscopic adrenalectomy report less pain and faster recovery time than patients undergoing classic open abdominal adrenalectomy.

Possible Complications:

During laparoscopic surgery, if the surgeon encounters excess scarring from previous surgeries, if the adrenal tumor or the adrenal size is larger than anticipated, or if the surgeon feels unable to appropriately visualize the structures in the abdomen, he or she may need to switch to a classic open abdominal adrenalectomy.

Other possible complications include:

• Nelson's syndrome, in which a pre-existing pituitary tumor begins to grow at an extremely fast rate, resulting in abnormal blood hormone levels and extreme hyperpigmentation of the skin
• Improper hormone balance
• Changes in blood pressure
• Slow wound healing
• Retained fluid
• Bleeding
• Infection
• Blood clots in the legs
• Pneumonia and other risks of general anesthesia
• Injury to nearby organs or structures

Average Hospital Stay

Classic open abdominal adrenalectomy: 4-7 days

Laparoscopic adrenalectomy: 1-2 days

Postoperative Care:

• You might require pain medications. Patients who have had a classic open abdominal adrenalectomy require stronger pain medications for a longer period of time after surgery than those who undergo the laparoscopic procedure.
• You may be nauseated for a few hours after surgery. Depending on various factors, your surgeon may have placed a nasogastric tube through your nose and into your stomach to drain accumulated fluids and stomach acid. You won't be able to eat or drink until this is removed and you're no longer nauseated, so you'll continue to receive fluids and sugar through an IV. Once you begin eating, you may need to eat a lighter, blander diet than usual.
• You may be given special compression stockings to wear after surgery to decrease the possibility of blood clots forming in your legs.
• You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently, in order to improve lung function after general anesthesia.
• Your body may be making substantially less natural steroid hormones, so your doctor may start you on steroid medications immediately after surgery.

Outcome

Recovery time after a classic open abdominal adrenalectomy may be as long as 4-6 weeks, while recovery time after laparoscopic adrenalectomy may be as short as one week to ten days.

You'll need to be carefully monitored to verify that your body is producing the right quantity of steroid hormones, or to verify that you're taking the correct dose of steroid medication.

You may be asked to weigh yourself daily and to report any weight gain of two or more pounds over 24 hours, as this may indicate that you are retaining fluid. You'll probably be asked to monitor your blood pressure regularly at home as well.

Try to increase your physical activity according to your doctor's instructions, in order to avoid any respiratory complications from the general anesthesia and in order to improve recovery of your digestive system.

Call Your Doctor If Any of the Following Occurs

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
• Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
• Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
• Pain and/or swelling in your feet, calves, or legs, sudden shortness of breath or chest pain

SOURCES:

Conn's Current Therapy 2000, 52nd ed. W. B. Saunders Co, 1999.

Textbook of Surgery, 15th ed. W. B. Saunders Co, 1997.

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Last reviewed February 2001 by Medical Review Board