Adrenalectomy

An adrenalectomy is surgery to remove one or both adrenal glands. Your adrenal glands are about the size of your thumb and found just above your kidneys. They produce hormones like adrenaline and cortisol that control essential functions in your body, such as your blood pressure and heart rate. Your doctor may recommend the surgical removal of the adrenal gland if you have a noncancerous or cancerous tumor in the gland or if your body makes too much of a hormone.

Penn Medicine specialists have extensive experience treating adrenal disorders, including tumors that are complex and rare. A team of surgeons from several specialties work together as part of your care to provide you with the most appropriate treatment based on your needs.

Surgery to remove one adrenal gland is known as a unilateral adrenalectomy, while surgery to remove both adrenal glands is known as a bilateral adrenalectomy. Removal of an adrenal gland may be done using minimally invasive surgery (laparoscopic surgery) or open surgery.

• Laparoscopic adrenalectomy: During this surgery, your surgeon removes the adrenal gland through one or more small cuts in your stomach. It usually requires a shorter hospital stay and faster recovery times compared with open surgery.
• Robotic adrenalectomy. In robotic surgery, your surgeon uses robotic arms to perform a laparoscopic procedure.
• Retroperitoneoscopic adrenalectomy: In this laparoscopic surgery, the adrenal glands are removed through one or more small cuts in your back rather than your stomach. You might have this type of adrenalectomy if you have tumors in both adrenal glands or if you’ve had abdominal surgery.
• Open adrenalectomy: This conventional surgery involves making a single, long incision in your stomach. You might need this surgery if the adrenal tumor is large, is connected to other organs, or is a certain type of cancerous tumor.

Your doctor may recommend an adrenalectomy if tests like an MRI or a CT scan reveal that you have a tumor in one or both adrenal glands. Often the tumor is not cancerous, but it can cause your adrenal gland to make more hormones than you need. This can cause headaches, sweating, changes in your heart rate, high blood pressure, and other symptoms.

Sometimes a tumor doesn’t cause any symptoms, and your doctor finds the tumor while doing an imaging test for something else. If blood and urine tests indicate that the tumor is causing higher than usual hormone levels, an adrenalectomy may be recommended.

You might need an adrenalectomy even if you don’t have a tumor. Sometimes the adrenal gland produces too much of a hormone on its own.

Your doctor may recommend that you get tests and take prescription medication before surgery. You might need to stop taking other medications leading up to the day of the operation, and you’ll be given instructions on when to stop eating and drinking.

At the hospital, you’ll be put to sleep using general anesthesia. If you’re having laparoscopic or retroperitoneoscopic surgery, your surgeon makes small incisions in your stomach or back and uses a tiny camera to find the adrenal gland. Then the surgeon uses surgical instruments to remove the gland. If you’re having a robotic adrenalectomy, your surgeon follows the same steps but will use robotic arms to remove the adrenal gland. If you’re having open surgery, your surgeon makes a larger incision in your stomach to access and remove the adrenal gland.

The entire adrenal gland is taken out to make sure none of the tumor remains in the body, and then your surgeon closes your incisions.

Adrenal gland removal surgery can have short-term side effects that may include mild to moderate pain, nausea, and vomiting. Your doctor may prescribe medication to ease these side effects and keep you comfortable. Nausea and vomiting usually go away in a day or two.

If you had minimally invasive surgery, you might go home the same day or stay overnight in the hospital. If you had open surgery, you’ll need to stay in the hospital longer, usually three to five days. Some people who have an adrenalectomy need to have their blood pressure monitored after surgery, and they’ll go to the medical intensive care unit in the hospital.

Follow your doctor’s instructions about how to clean your incision and when you can take a shower. You should be able to return to your usual activities within a week of having surgery, but avoid vigorous activities, heavy lifting, and movements that strain your stomach until your doctor says they’re OK. Strenuous activity could lead to a hernia after an adrenalectomy.

Your doctor will let you know if you need to take hormones for a longer period after surgery. After an adrenal gland is removed, the other adrenal gland ramps up the production of hormones to make up for the one that’s gone. But because it can take time for the gland to make enough hormones for your body to function, you’ll need to take hormone supplements. If you’ve had both adrenal glands removed, you’ll need to take hormone supplements for the rest of your life. Blood pressure medications may be needed long-term for certain types of adrenal glands.

Call your doctor if you have any symptoms that are concerning after surgery and be sure to go to all your medical appointments. Your care team will provide ongoing support and follow-up testing as needed to ensure that your recovery is on track.

Like any surgery, removal of an adrenal gland has risks, like a reaction to anesthesia, infection, bleeding, or problems with the incision’s healing. An adrenalectomy can also cause high or low blood pressure and hernias. Rarely, blood clots, a heart attack, or lung problems can occur after the procedure.

These risks are generally uncommon, and an adrenalectomy is considered a safe procedure when done by a surgeon experienced in adrenal gland removal. Be sure to talk with your doctor if you have questions about the risks associated with the surgery.

Leaders in adrenal gland health and research

Adrenalectomies are complex surgeries that require extensive training and expertise. When you come to Penn Medicine, you can expect to receive the highest level of care to treat a range of adrenal tumors and conditions.

• Expert care close to home: Penn Medicine surgeons were the first in the southeastern Pennsylvania and New Jersey regions to conduct retroperitoneoscopic adrenalectomies. We perform innovative treatments based on the latest research.
• Treatment for rare cases: Our specialists treat more people with aldosterone-secreting tumors and rare catecholamine-secreting tumors than almost any other health-care system in the United States. People rely on our expertise to treat even the most complex and rare adrenal tumors.
• Wide-ranging services: Our radiology services are ranked high in the nation for adrenal sampling, which helps identify people who could benefit from surgery. We focus on providing precise and individualized treatments for people with adrenal conditions.