The adrenal glands are triangular shaped glands that sit on top of the kidneys. They produce a number of hormones including cortisol, aldosterone, sex hormones and adrenaline.
Common Reasons for Considering Surgery on the Adrenal Glands
- Overproduction of adrenal hormones
In most cases only one hormone will be overproduced by the adrenal gland. This is usually due to a benign tumour of one of the adrenal glands. Symptoms relate to the specific hormone that is overproduced but may include changes to blood pressure, weight, heart rate, body potassium levels or appearance.
- Enlarged adrenal gland
The normal adrenal gland is between 1 and 3cm in size. A mass on the adrenal gland may be found on a scan of the abdomen performed for other reasons (most often a CT scan). Even when this mass does not produce adrenal hormones, a large mass has an increased risk of adrenal cancer. Adrenal cancer is rare even in large adrenal masses however the only curative treatment is surgery. Hence, where an adrenal mass is large or increasing in size, surgery may be considered.
Surgery on the Adrenal Glands
Posterior Laparoscopic Adrenalectomy
In most cases the adrenal gland can be removed via a laparoscopic (keyhole) operation from the back. This is performed under general anaesthetic with three small incisions beneath the rib cage on the back. The operation offers a more direct approach to the adrenal gland and the operative time is decreased. Most patients after this operation spend only 1-2 nights in hospital. This approach is relatively new (within the last 5-10 years in Australia) and Dr O’Neill is the only surgeon in the Hunter to offer this approach for adrenal surgery.
In some cases a posterior approach is not feasible but patients may be suitable for an anterior laparoscopic adrenalectomy. This operation is involves 3-4 small incisions in the abdomen. After laparoscopic adrenalectomy most patients will stay in hospital 2-3 nights. It is occasionally necessary to convert a laparoscopic adrenalectomy to an open adrenalectomy.
In patients with very large adrenal tumours (larger than 10cm) or where there is a high risk of cancer, open adrenalectomy is performed. This involves a surgical incision in the side (just below the ribs) and a longer stay in hospital after surgery (five to seven days).
Risks of Adrenal Surgery
The risks of adrenal surgery are small, however any operation has risks and these can include:
The adrenal gland is a very vascular structure and runs adjacent to very large vessels. Great care is taken during surgery to minimise the risk of bleeding and only rarely does significant bleeding occur. In these rare instances blood transfusion may be required.
- Complications Related to Adrenal Hormones
Where the adrenal gland is overactive, medication may be necessary to control the adrenal hormones prior to surgery. Certain types of adrenal tumours can increase the blood pressure to very high levels. Some patients will require intensive monitoring of blood pressure in the intensive care unit after surgery. The blood pressure can be controlled with medication and usually only a short period of intensive monitoring is necessary. If this is the case Dr O’Neill will discuss this with you prior to your surgery. After removal of one adrenal gland, the remaining adrenal gland is almost always able to produce sufficient adrenal hormones. Where the adrenal gland was overproducing cortisol prior to surgery, steroid tablets will usually be required after surgery. Most patients can be weaned off these over the months following surgery.
In addition to these risks any operation with a general anaesthetic is associated with risks to your health. Serious complications in healthy patients are extremely rare. Potential problems can include:
- Heart problems (heart attack, stroke, death)
- Lung problems (pneumonia)
- Blood clots (clots in the legs or lungs)
- Drug reactions
It is important that you tell Dr O’Neill and your anaesthetist if you have any other medical conditions or take any regular medications prior to your surgery.
Other helpful websites with information on adrenal glands: