The adrenal gland is an endocrine gland located above the kidney. Its function includes the production of hormones, including adrenaline, cortisol, aldosterone, and certain sex hormones. These hormones are released into the bloodstream and influence various target organs according to their physiological function. Sometimes, the adrenal gland's normal function is compromised for various reasons, and in such cases, surgical removal is necessary.
The reasons for adrenalectomy include tumors or masses in the adrenal gland that cannot be characterized through needle biopsy, and overactivity of the gland due to conditions like Cushing's syndrome (resulting in excess cortisol production), Conn's syndrome (resulting in excess aldosterone production), or pheochromocytoma (resulting in excess adrenaline production).
Possible complications of the surgery include decreased cortisol production (leading to various physiological problems), low blood pressure, bleeding, infection at the surgical site, in the urinary tract or lungs, the formation of blood clots in the legs, damage to adjacent organs during the surgery, and anesthesia-related complications.
Factors that may increase the risk of complications include being an older adult (aged 60 and above), being overweight, prolonged exposure to excess cortisol before the surgery, smoking, poor nutrition, chronic or acute illnesses, heart or lung problems, alcoholism, the use of certain medications (such as steroids, muscle relaxants, and sedatives), and drug use (e.g., LSD, amphetamines, marijuana, or cocaine).
It is important to provide the doctor with a complete medical history, considering the risk factors, to tailor the safest treatment.
Before the surgery, a physical examination, blood tests, urine tests, and imaging (such as abdominal ultrasound, abdominal or brain CT, or MRI) will be conducted. The doctor should be informed about all medications taken regularly. The doctor may instruct to discontinue the use of certain medications or adjust their dosage (e.g., aspirin, Coumadin, and Clopidogrel). In case of uncontrolled high blood pressure, it will need to be stabilized before the surgery. Eating and drinking should be avoided from midnight before the surgery.
Enemas or laxatives might be administered to cleanse the intestines. Intravenous fluids, antibiotics, and steroids will be provided as needed.
The surgery is performed under general anesthesia using a laparoscopic approach, with the patient lying on their side. The procedure takes 2-3 hours. The doctor makes 3-4 small incisions in the abdomen. A tiny camera is inserted through one of them. To create a convenient working space, the abdomen is inflated with carbon dioxide gas. Additional instruments inserted through the other incisions are used to separate the adrenal gland from the kidney. After separation, the adrenal gland is removed through one of the incisions. The incisions are closed with sutures or staples and dressed. In some cases, a drain (thin tube) may be left near the area of the adrenal gland removal to drain any accumulated fluids. The drain is usually removed within a week of the surgery. It should be noted that the surgeon may decide to switch to open surgery if faced with an issue that cannot be resolved using the laparoscopic approach.
Despite minimizing discomfort, post-operative pain is expected. Pain relief will be provided as needed and under the guidance of the pain service. After the surgery, the patient will be monitored in the recovery room and continue the hospitalization in the surgical department. The average hospital stay after the surgery is 2-3 days.
The diet will be gradually resumed after the surgery, and steroids may be administered. Before discharge, the doctor will provide instructions regarding diet and activity tailored to the patient's condition. Compression stockings should be used to prevent blood clots. The physiotherapy team will guide and assist with appropriate breathing exercises. It is recommended to get out of bed several times a day; walking accelerates the healing process and reduces the risk of complications such as pneumonia.
The healing process usually takes about two weeks, during which the family doctor will monitor cortisol levels in the blood and gradually taper the oral steroid treatment. The patient should weigh themselves daily, as weight gain may result from fluid retention, and it should be reported to the doctor. Blood pressure should also be monitored, and the patient should follow the doctor's instructions regarding the recovery period and follow-up care.
After being discharged from the hospital, promptly contact your doctor if you experience any of the following:
- Signs of inflammation, including fever and chills
- Redness, swelling, increasing pain, excess drainage, or discharge from the incision site
- Nausea or vomiting
- Uncontrolled pain
- Uncontrolled urination, continuous urinary leakage
- Cough, shortness of breath, or chest pain
- Pain or swelling in the feet or ankles
- Headaches
- Dizziness
- Any new symptoms.