Adrenalectomy

Adrenalectomy is a surgery to remove one or both of the adrenal glands. Adrenal glands lie on the top of the kidneys and produce many hormones that are vital for the proper functioning of the body. These hormones help control your blood pressure, blood sugar, electrolyte balance, and many more functions. 

It also produces hormones that help us fight stress. At times tumors or cyst in them will cause an increase in the production of these hormones and chemicals. This imbalance will create many problems in the body. If medicines do help, you will have adrenalectomy.

During this, the doctors will remove the gland with the problem. You can have a healthy life by having a single adrenal gland in your body. If you have problems with both the adrenals, the doctors will remove both of them. Then you will have to take some hormonal supplements for the rest of your life.

You may have open or laparoscopic surgery, depending on a few things. Having a laparoscopic surgery will make the recovery process easy and reduce risks.

Functions of adrenals

Your adrenal gland has two parts. The outer cortex secretes hormones like cortisol and aldosterone, etc. Hormones like adrenaline and noradrenaline come from the inner medulla.

These hormones are essential to normal functioning in the body. It

• Helps you to fight stress
• Aids in the metabolism of fat, proteins, etc
• Helps to keep your blood sugar and blood pressure levels within limits
• Aids in regulating the salt and water balance in your body
• Helps the fetus to develop during pregnancy
• Assists in the sexual changes that you will have before and during puberty
• Helps to keep the level of sex hormones in your body in check

Your adrenals will produce these hormones, as is necessary. In those with adrenal problems, there will be a rise in the levels of some of these. It can upset the functions they perform and cause many health issues.

Adrenalectomy- Why to do

Your adrenal produces many hormones to control various things in the body to keep you healthy. But some diseases to the adrenals can make it overactive. It may affect one or both glands. So naturally, there will be an increase in the levels of some hormones. 

You will have medicines to keep the level of the hormones down as an early treatment. In some people, medicines will not help the situation. In such cases, the doctor will think of removing the gland with the problem. 

If you have a small tumor in one of the adrenals, the doctor may remove the tumor from it. If the cancer is large, the doctor will remove the entire gland. You can have a healthy life with a single adrenal. 

Some diseases will affect both the glands. In that case, the doctors will remove both of them. You will then have hormonal supplements for the rest of your life.

When to do an adrenalectomy

Adrenal tumors are the most common problem that will need the removal of the gland. The tumors may be benign or malignant. Some of the common conditions that may need adrenalectomy include

• Benign adrenal tumors that cause Conn's Syndrome or Hyperaldosteronism, Cushing's Syndrome, Pheochromocytoma, etc
• Adrenal hyperplasia where the adrenals enlarge in size
• Malignant tumors of the adrenals
• Benign tumors that are larger than 3 to 4cm

Adrenalectomy procedure

There are two ways to have adrenalectomy. One is a minimally invasive surgery, and the other is an open operation. In a laparoscopic procedure, the surgeon will make 3 or 4 very small incisions. He or she will remove the gland with the help of a small camera and miniature instruments. You will recover faster with laparoscopic surgery. The risks and complications are also less.

The type of surgery you will have will depend on 

• The size of the tumor
• The type of tumor
• History of abdominal surgery

Laparoscopic adrenalectomy

You will have general anesthesia during this. So you will sleep through the procedure. Once you are asleep, the surgeon will make two or three small incisions in the areas marked before. Through one of these, the surgeon will insert a small camera to see the adrenals clearly in a monitor. Through the other incisions, the surgeons will insert special surgical instruments to remove the gland.

It is ideal for removing tumors that are less than eight centimeters. It is not possible to remove adrenal cancers through this method.

In almost two percent of patients, the surgeons will have to convert a laparoscopic surgery to an open one. It is mainly due to unfavorable abdominal anatomy, signs of cancer in the adrenals or nearby areas, etc.

There are some benefits of laparoscopic surgery. They are

• Discomfort after surgery is less
• Healing is faster
• Smaller scars
• Shorter hospital stay

Open adrenalectomy

In this surgery, the surgeon will make one long incision in your abdomen to remove the adrenal gland. You will have this if

• You have an adrenal cancer
• The tumor is more than 10cm in size
• You have an unfavorable abdominal anatomy
• You had a previous abdominal surgery 

There are three types of approaches to reach your adrenals. They are

1. A transabdominal approach where the surgeon will make a vertical cut in the middle of the abdomen
2. A thoracoabdominal approach where the incision is a large one extending from the diaphragm to the middle of the abdomen
3. Retroperitoneal abroach where the surgeon will make the incision below the eleventh rib

Partial adrenalectomy

You will have this surgery if there are problems with both your adrenals. In this surgery, the doctors will leave a part of the adrenal cortex behind if the area is free of the disease. This area will produce some amount of cortisol to reduce your dependence on steroid supplements for the rest of your life.

Recovery after adrenalectomy procedure

At hospital

You will awake from anesthesia in the recovery room. It is natural for you to feel drowsy and very tired. You can eat and drink a few hours after the surgery. There will be a catheter to remove urine. There will also be a drain to collect fluids that form in the site of surgery.

If you have pain, you will have pain killers. The doctors will ask you to walk around to get your blood flowing nicely through the body. It will help in wound healing and prevent any blood clots in the veins.

If you have open surgery, you will be in the hospital for about 4 to 5 days. If it is a laparoscopic one, you will be able to go back the next day.

At home

You will be able to go back to your routine life in about 2 to 3 weeks. You will have to take a few steps to avoid any complications. These include

• Taking adequate rest
• Avoid climbing stairs very often
• Not to lift anything heavy
• Not to bend below your waist
• Take short walks now and then
• Sticking to the prescribed diet

You will have to take good care of your wound to prevent any infections. Always keep it clean and dry. While bathing, make sure that you are not making the incision wet.

Risks and complications of adrenalectomy

Some of the common risks include

• Bleeding after surgery
• Pain after surgery
• Reactions to medicines
• Blood clots in the large veins of the legs
• Changes in blood pressure
• Adrenal insufficiency