Adrenal surgery

The adrenals are endocrine glands which are attached to the upper part of the kidneys. They produce important hormones such as adrenaline, aldosterone, cortisol or testosterone. Adrenal tumours can cause overproduction of these hormones. Overproduction of cortisol causes Cushing's syndrome. If too much aldotestosterone is produced, this is known as Conn's syndrome. An overproduction of adrenaline is caused by a special tumour known as a phaeochromocytoma. Overproduction of adrenal hormones leads to serious complaints such as raised blood pressure, cardiac arrhythmias, tiredness, muscle weakness and increased thirst. Therefore, tumours of the adrenals must usually be surgically removed, irrespective of whether they are benign or malignant.

What preparations are carried out before the procedure?

Overfunction of the adrenal glands is diagnosed with a blood and a urine test. The exact position of the tumour in the adrenals is determined by ultrasound, computer tomography, MRI or a special radiological examination known as a scintigraphic scan.

If the patient has high blood pressure, this must be treated beforehand to prevent hypertensive crises occurring during the surgery.

As is standard before all operations, all blood-thinning medication must be discontinued beforehand. The operation is performed under general anaesthetic. Patients should therefore have an empty stomach for the procedure.

How is the operation performed?

Adrenal surgery is performed under general anaesthetic. Depending on the situation, access is gained to the adrenal s via an abdominal incision (laparotomy) or an incision in the patient's side. However, this procedure is usually undertaken with a laparoscopy. During this minimally invasive procedure, a video camera and surgical instruments are inserted into the abdominal cavity via small incisions.

Depending on the type of tumour and the extent of the disease, the adrenal gland is completely (total adrenalectomy) or only partly (partial adrenalectomy) removed. However, the adrenals are usually only affected on one side, so only the adrenal gland on the affected side will need to be removed. If a patient has adrenal carcinoma, which is extremely rare, the surgery must sometimes be extended to neighbouring organs such the kidneys or the liver.

What is the success rate of this procedure?

The rate of recovery and the prognosis after adrenal surgery depend on the type of underlying disease. In the case of predominantly benign tumours such as adrenal adenomas or phaeochromocytomas, the disease is normally remedied by surgically removing the adrenal gland. The prognosis for patients with malignant tumours such as adrenal carcinomas or adrenal metastases, the prognosis depends on the spread and the aggression of the tumour.

What are the possible complications and risks of this procedure?

As with all surgery, the surgery may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots. Sometimes adhesions in the abdominal cavity occur after the operation. If the tumour is a phaeochromocytoma, the surgery can sometimes cause an increase in blood pressure with dangerous circulatory problems.

What happens after the operation?

As is standard after abdominal procedures, the patient's bowel function and urinary output will be monitored after the surgery. If things progress normally, they can usually leave the hospital again in four to five days.

People who have undergone this operation should avoid major physical exertion when they are at home in the first two or three weeks. After a one-sided adrenalectomy, no hormone substitution is usually required as the adrenal glands on the other side of the body will still produce sufficient hormones. If the patient has undergone bilateral adrenal gland removal, the hormones, in particular cortisol, must be replaced for the rest of their life.

Follow-up treatment after the removal of malignant tumours will be based on the stage of the cancer. The patient may require radiotherapy or chemotherapy.