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Adrenalectomy

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on August 18, 2021.

You have two adrenal glands. One sits atop each kidney. The adrenal glands produce hormones that your body needs to function properly. If you develop cancer of the adrenal glands, surgery is often used to treat it.

Surgery to remove adrenal glands is called adrenalectomy. It may also be performed if you have kidney cancer and an adrenal gland needs to be removed along with a kidney. If the cancer has spread, your surgeon also may remove nearby lymph nodes and other tissue.

An adrenalectomy may be performed in one of two ways.

Open surgery: This surgery requires the surgeon to make a large surgical incision to remove the adrenal gland. Open surgery may be recommended if your tumor is large when it’s discovered. Usually, you’re in the hospital for a few days after open surgery.

Minimally invasive surgery: Considered the gold standard for adrenal tumors, this surgery is done through a series of small cuts above the kidney. The surgeon uses tiny instruments and a video camera inserted through these small cuts to guide removal of the adrenal gland. This is known as laparoscopic surgery. Some surgeons employ the use of a surgical robot to guide them. This is known as robotic surgery.

You may be able to go home the day after a minimally invasive surgery.

Your care team may not be able to perform a minimally invasive surgery if:

  • You’re obese
  • You have scars from past surgeries
  • Bleeding or other issues make it difficult for your surgeon to see
  • The tumor is large and has started to grow into nearby tissue (laparoscopic surgery isn’t recommended if the tumor is large because the surgeon would have to break the tumor into pieces to remove it, and that could potentially cause the cancer to spread)

You and your doctor will determine which surgery is most appropriate for you.

Once the adrenal gland is removed, it’s sent to a laboratory where a pathologist examines it under a microscope.

Surgery for adrenal carcinoma

Surgery to remove the adrenal glands is often recommended as a treatment for those with:

Stage 1-3 adrenocortical carcinoma: The adrenal gland is removed, and nearby lymph nodes may be removed if they’re larger than normal.

Stage 4 adrenocortical carcinoma: You may have surgery to remove cancer that has spread near the adrenal cortex. Most tumors develop in the outer part of the gland known as the cortex. The surgery in this case is palliative therapy, and it’s meant to relieve symptoms and improve quality of life.

Your care team also may recommend surgery if the adrenal cancer has recurred.

Other reasons for an adrenalectomy include:

  • You have an adrenal gland tumor.
    • Pheochromocytoma causes severe headaches, a rapid heartbeat and high blood pressure
    • Aldosteronoma causes high blood pressure, low potassium levels, weakness, muscle cramps and frequent urination
  • You have Cushing’s syndrome, a disorder caused by excess cortisol
  • You have kidney cancer. If you’re undergoing a radical nephrectomy, where your surgeon removes the entire kidney, your adrenal gland is removed as well. However, if your kidney tumor is located away from your adrenal gland and tests showed your adrenal gland wasn’t affected, it may not need to be removed.

How to prepare for an adrenalectomy

Before your surgery, be sure that you:

  • Arrange for someone to drive you to and from the hospital. You won’t be able to drive right away if you’re given general anesthesia.
  • Speak with your doctor about which surgery is planned and what steps need to be taken afterward.
  • Tell your care team about any medications you take, including those that are over-the-counter. Ask which, if any, you shouldn’t take on the day of your procedure.
  • If you take a blood thinner, for example, ask when you should stop prior to your surgery and when it’s safe to resume. Blood thinners may cause you to bleed excessively.
  • Make sure your care team has a copy of your advance care plan. If you don’t have one, think about getting one.
  • Make sure you have photo identification to bring with you to the hospital.
  • Ask your care team when to stop eating and drinking before the procedure.
  • Ask your care team how much assistance you may need with daily activities after surgery and make the necessary arrangements.
  • Take a bath or shower with antibiotic soap (if your doctor requests it) the night before or in the morning, but don’t use lotions, perfumes, nail polish or deodorant.

If you have a tumor known as a pheochromocytoma, and it’s causing high levels of the catecholamine hormone, your doctor may request that you drink lots of liquids and eat a high-sodium diet for a week before surgery.

How open adrenal surgery is performed

If you’re having open or laparoscopic surgery, you will be given general anesthesia. The surgeon makes an incision through the front of your abdomen to better see where your tumor is, how big it is, and whether it’s spread.

If your tumor is small, your surgeon may opt to make the incision in your back and approach the gland from just below your ribs.

If you’re having laparoscopic surgery, the incisions will be small. Your surgeon inserts a small narrow tube through the incisions as well as a camera. After separating your adrenal gland from your kidney, the surgeon will place it in a small bag that’s removed from your body.

Your surgeon will also determine whether nearby lymph nodes and other tissue need to be removed. They’re likely to be removed if they appear to be larger than normal.

Finally, your incisions are closed.

Some patients have adrenal cancer that has grown into their inferior vena cava, the vein that carries blood from the lower half to the heart. It may be difficult to remove the tumor in its entirety and not damage the vein, so the patient may need to be put on may need a heart-lung bypass machine while the surgeon is removing the tumor from this vein.

Risks of an adrenalectomy

Possible complications of adrenal gland removal include:

  • Bleeding
  • Blood pressure that rises too high or falls too low
  • Injury to organs that are nearby
  • Infections
  • Blood clots
  • Heart attacks (rarely)
  • Lung problems (rarely)

Call your care team if you experience any of these signs of an infection:

  • Fever of 101°F or higher
  • Bleeding or pus coming from your incision
  • Swelling in your abdomen or a sunburn-like redness around your incision
  • Nausea, vomiting or difficulty eating
  • Chills
  • Difficulty breathing
  • Extreme fatigue

Also, call your care team if:

  • Your stitches loosen
  • You have pain and medications do not help

Recovery from surgery

Expect some pain after surgery. The incision area may be sore for one to two weeks.

Medications: You may relieve your pain with over-the-counter medications such as Tylenol® (acetaminophen) or Advil® (ibuprofen). You may need a small amount of narcotic pain medicine for a few days. Ask your care team about getting a prescription.

Ice: Icing your incision may reduce swelling and help relieve pain.

Rest: You may feel fine, but you need to give your body time to heal. You may do light activities once you’re home. Don’t lift objects heavier than a gallon of milk. You should be able to resume your normal activities about a week after surgery. Ask your doctor when you may resume driving.

Hormone replacement: Check with your doctor regarding any hormones that your adrenal gland made that should be replaced. Some people may need medication to replace the hormone aldosterone, as well as blood pressure medications.

Use a pillow: Keep a pillow handy to use when you cough, sneeze or take deep breaths. Place it over your incision to give you support.

Start back slowly: Moving around, once your doctor says it’s OK, is also important. Walking is a good activity to start with.

Eat normally: You likely won’t need to eat a special diet once you’re home. However, if you have an upset stomach as a result, keep your meals bland with foods such as plain rice, toast, yogurt and broiled chicken. If you’re constipated, be sure to drink lots of water and eat more fiber. Ask your care team if you need to take a stool softener or mild laxative.

Check your potassium: If your tumor made the hormone aldosterone, your doctor may ask you to have your potassium levels checked to determine whether you need blood pressure medication.

Post-surgical treatment

If you have stage 1 or stage 2 adrenal cancer and your entire gland was removed during surgery, you may need no further treatment. However, if your tumor wasn’t completely removed, you may also need radiation or chemotherapy.

If you have stage 3 cancer and your entire adrenal gland was removed as well as some surrounding tissue (perhaps part or all of your nearby kidney and part of your liver, and lymph nodes), you may need additional treatment such as radiation and chemotherapy.

If you have stage 4 cancer, it isn’t likely your surgeon was able to remove all of the cancer that has spread elsewhere. Your care team may recommend follow-up radiation and chemotherapy. Follow-up treatments may begin right away, or not until you’re having symptoms.

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