The adrenal glands are small but important organs located just above the kidneys. They release hormones that regulate salt levels in the blood, the body’s response to stress, and blood pressure amongst other things. In addition, the adrenal glands make some of the sex hormones.
A tumor that occurs in the adrenal gland can cause the release of too much of a particular hormone. Some of the more common tumors that produce hormones include:
- Pheochromocytoma- This tumor produces hormones that can cause spells of seriously elevated blood pressure and heart rate. It can also cause headaches, anxiety, palpitations and excessive sweating.
- Aldosteronoma- This tumor produces a salt-regulating hormone called aldosterone. Patients may have elevated blood pressure and low blood potassium levels.
- Cortisol-producing tumors can increase obesity (usually of the face and trunk), increase blood sugar, increase blood pressure, and produce thin skin and increased stretch marks. This is called Cushing’s syndrome.
- Sex-hormone-producing tumors can cause increased breast tissue, baldness, or increased body hair depending on the hormones it produces.
- Other tumors of the adrenal include fatty tumors, cancers of other organs that have spread to the adrenal glands, and benign tumors that don’t produce any hormones.
Diagnosis: Your doctor may check for an adrenal tumor if you have certain medical problems, but many times a tumor will be found if you are getting an X-ray test for something else. Certain blood and urine tests can be done to see if the tumor is making any of the various hormones
There are different reasons to have the adrenal gland removed
- The tumor creates excessive hormones.
- The tumor is large in size (4-5 cm).
- The tumor might be malignant. (Increased size increases the chance of malignancy.)
If the decision is made to remove the adrenal gland, there are two options for surgery: laparoscopic surgery or traditional open surgery. Your surgeon will discuss the best approach for you. The benefits of laparoscopic surgery include smaller incisions, decreased hospital stay, decreased recovery time and decreased risk of wound infection and hernia.
Occasionally the surgery cannot be performed laparoscopically. Some of the reasons include very large tumor size, or previous surgery or scar tissue in the region of the adrenal gland. Sometimes surgery can be started laparoscopically, but needs to be converted to an open incision during surgery. This is usually because your surgeon determines that the surgery cannot be completed safely through the scopes. This is a decision made by your surgeon in the operating room and is made with your safety in mind.
Before and After
The preoperative period
Before the surgery, you will likely need some blood tests and X-rays. Some patients will need medical clearance for surgery. Your surgeon will go over the risks of surgery, and may want you to cleanse your colon prior to surgery. You may need to take specific medication before surgery, depending on the type of tumor you have. Blood thinners, aspirin and some herbal remedies need to be stopped prior to surgery. After surgery, most patients will go to a regular surgical floor in the hospital. Some patients (especially patients with Pheochromocytoma) will need to go to the ICU for more intensive monitoring.
You will be expected to walk the night after surgery and will need to cough and take deep breaths. Most patients will go home in a day or two if the surgery is done laparoscopically. A longer hospital stay is usually necessary for the open surgery. Most patients are able to get back to normal activities within a week. Some patients with certain tumors will need to have blood chemistry checked and some will have to continue steroids or blood pressure medication after surgery.
All surgery has risk associated with it. Some of the risks of this surgery are:
- The risk of general anesthesia
- Elevated blood pressure
- Injury to abdominal and nearby organs
- Recurrence of tumor
- Organ dysfunction or failure
- Blood clots
Make sure you call your doctor if you have a fever over 101°F, pus or drainage from incisions, bleeding, dizziness, shortness of breath, nausea or vomiting, or anything out of the ordinary that is concerning you.
Most patients are able to get back to normal activities within a week or two.