Adrenalectomy

About Adrenalectomy

Adrenalectomy is the surgical removal of one or both adrenal glands, small endocrine glands that sit above the kidneys and produce hormones such as cortisol, aldosterone and adrenaline. It is performed for hormone producing tumors, including aldosterone producing adenomas causing primary aldosteronism, also called Conn syndrome, cortisol producing tumors causing Cushing syndrome, and pheochromocytomas, which release adrenaline like hormones. It is also performed for adrenal masses that are large or have imaging features suspicious for cancer, for adrenocortical carcinoma and for some metastases to the adrenal gland. Laparoscopic adrenalectomy, first reported by Michel Gagner and colleagues in 1992, has become the standard approach for most benign tumors and can be performed through the abdomen with the patient lying on one side or through the back in a retroperitoneoscopic approach. Robotic surgery is also used. Open surgery is generally preferred for large or clearly malignant tumors to allow complete removal without breaching the tumor. Pheochromocytoma surgery involves careful preoperative medical preparation, usually with alpha adrenergic blockade, to reduce the risk of dangerous blood pressure swings when the tumor is handled, and close anesthetic monitoring during surgery. In hereditary syndromes such as multiple endocrine neoplasia type 2 and von Hippel Lindau disease, cortical sparing surgery may preserve enough adrenal tissue to avoid lifelong steroid dependence. After bilateral adrenalectomy, permanent replacement of glucocorticoid and mineralocorticoid hormones is required, and in Cushing disease there is a risk of Nelson syndrome, growth of the underlying pituitary tumor. Complications include bleeding, temporary adrenal insufficiency and injury to nearby organs.