Adrenal glands
Why adrenal lesions need careful assessment
The adrenal glands sit above the kidneys and produce hormones involved in blood pressure, metabolism, stress response and salt balance. Adrenal masses are often discovered incidentally on scans performed for another reason.
Hormone-producing tumours
Phaeochromocytoma, Conn’s syndrome & cortisol-producing tumours
Adrenal tumours may produce excess catecholamines, aldosterone or cortisol. Symptoms can include difficult-to-control high blood pressure, palpitations, headaches, sweating, low potassium, weight change, muscle weakness and metabolic problems.
Hormonal testing is an essential part of the assessment before surgery is considered.
Cancer
Adrenocortical carcinoma & metastases
Adrenocortical carcinoma is rare and can be aggressive. Complete surgical removal offers the best chance of cure when disease is resectable. The adrenal glands can also be a site of metastasis from other cancers, and surgery may be considered in selected patients with isolated disease.
Adrenalectomy
Surgical approaches
Adrenalectomy may be recommended for hormone-producing tumours, enlarging masses or suspected or proven malignancy. Most suitable benign and selected smaller malignant lesions can be approached laparoscopically or robotically, while large or invasive tumours may require open surgery.
After surgery
Recovery and hormone replacement
After removal of one adrenal gland, the remaining gland usually provides sufficient hormone production. Patients who have both adrenal glands removed require lifelong steroid replacement and specific education about adrenal insufficiency.
Recovery after minimally invasive adrenalectomy is generally faster than after open surgery, but the exact hospital stay and return to activity depend on the operation and underlying condition.
Book an appointmentRisks of adrenal surgery
Important risks and complications
As with any major operation, adrenal surgery has general surgical risks as well as risks specific to operating around the adrenal gland.
General risks
These include infection, bleeding that may require further treatment or another operation, chest infection or partial lung collapse, heart attack or stroke, blood clots in the legs or lungs, and—in rare circumstances—death. These risks may be higher in people with obesity or significant medical problems.
Adrenal-specific risks
Depending on the type of adrenal tumour, major changes in blood pressure can occur during surgery and may affect the heart or circulation to the brain. Injury to nearby major blood vessels can cause severe bleeding and may require transfusion or further surgery. Bowel injury can cause leakage of bowel contents, peritonitis or sepsis and may also require further surgery. Temporary difficulty passing urine, intra-abdominal infection, bowel paralysis or obstruction, wound problems, hernia, keloid scarring and adhesions can also occur.
If both adrenal glands need to be removed, long-term hormone replacement medication will be required.