The adrenal glands are two thumb-sized glands located atop your kidneys. Each of your adrenal glands is made of two parts that act as separate glands. The outer portion is the cortex, and the inner portion is called the medulla. The hormones that come from adrenal glands control your blood pressure, alter chemical levels in the blood, regulate water and glucose usage in the body, and are responsible for your “fight or flight” reactions during times of stress. The hormones produced by your adrenal glands include cortisol, aldosterone, and adrenaline (epinephrine and norepinephrine). The adrenal glands are also responsible for a small fraction of your body’s sex hormones (estrogen and androgens). If you’ve heard stories of parents lifting up impossibly heavy things to save their children or have ever reacted automatically to situations that are life-threatening, you have observed or experienced the effects of hormones produced by your adrenal glands.
What Can Go Wrong With Adrenal Glands?
When your adrenal glands don’t produce enough hormones, it is known as hypofunction, which results in Addison disease. This disease is characterized by muscle atrophy (loss of tissue), weakness, skin pigmentation, and disturbances in salt and water balance. When your adrenal cortex produces too much hormone, it is known as hypersecretion, which results in a condition known as Cushing syndrome. Cushing syndrome causes symptoms of obesity with a round, “moon” face, thin skin that bruises easily, muscle weakness, bone loss, and elevated blood sugar. Using steroid drugs may also produce these symptoms. Aldosteronism is the term for when your adrenal cortex produces excess amounts of aldosterone. Tumors of your adrenal glands give rise to a wide range of symptoms. These symptoms result from your adrenal glands producing either too much or not enough of a particular hormone.
Pheochromocytomas tumors produce excess hormones causing high blood pressure and spells of severe headaches, sweats, anxiety, heart palpitations and rapid heart rate that may last a few seconds or even several minutes. Aldosterone-producing tumors cause high blood pressure and symptoms of weakness, fatigue, and frequent urination. Cortisol-producing tumors cause Cushing’s syndrome. Masses in the adrenal don’t always produce hormones. Most are benign and don’t require removal. The most common reason a patient may need to have the adrenal gland removed by a surgeon is when too much hormone is produced by a tumor located within the adrenal gland. Most of these tumors are benign and small and can be removed with laparoscopic (minimally invasive) surgical techniques. If the tumor is very large (4-5 cm in diameter) or there is suspicion it may be malignant, surgery will be required. Malignant adrenal tumors are rare. Usually, these adrenal tumors, whether malignant or benign, are found by chance during x-rays.
Before you schedule an appointment with a surgeon, you will need to provide medical records, radiology images (CT/CAT or MRI), and lab test results for cortisol, aldosterone, metanephrines, and catecholamines, if available.
Once you are scheduled, you will have another pre-operative evaluation by your surgeon’s secretary about a week before the surgery. This assessment includes medical history, a physical, laboratory studies, chest X-rays, urine test, and EKG. You will also need to prepare your bowels for surgery with a phosphor-soda prep kit that you can get over-the-counter at any pharmacy. You will also have to be on a clear liquid diet starting 24 hours before your surgery.
On the day of your surgery, you will probably be required to arrive at least two hours before your scheduled surgery time. You will be given general anesthesia and will be placed on your back or your side depending on the location of the. A catheter inserted into your bladder will drain your urine. A small tube will be inserted through your mouth into your stomach, and it will help to keep your stomach empty and prevent nausea or vomiting.
In the past, a large six to twelve-inch incision in the abdomen, flank, or back was necessary for removing adrenal gland tumors. These days, minimally invasive surgery is the norm, unless the tumors are exceptionally large. Instead of large incisions, the surgeon will make three or four 1/4 or 1/2 inch incisions. The incision/incisions are stitched closed and covered in steri-strip and dressed in dry gauze. The operation usually takes around two to four hours. Because it is not open surgery there is a less recovery time; patients can return to work more quickly, reduced risk of herniation, and improved cosmetic results.
Post-Op for Adrenal Surgery
After your surgery, you will stay in the recovery room for several hours. The evening of surgery you will have a liquid diet for dinner, but don’t worry— in the morning you will be offered regular food. Your nurse will give you pain medicine as needed. You may be gently encouraged to get out of bed and take a short walk the night of your surgery. Soreness in the throat is also common, because of the anesthesia tubes placed during surgery. Throat sprays and lozenges usually help. If you are having a minimally invasive procedure, you will most likely be ready to go home after breakfast in the morning. If you are having open surgery, you will probably have to stay in the hospital for three to five nights.
After you’re discharged, you can resume your regular diet, and make sure to continue medications you were on before surgery. You will also be given a prescription for postoperative pain, which you should take only as needed. You can resume your normal activities after adrenal surgery, but you may be tired or experience muscle soreness at first. Do not drive while on narcotic pain meds, and make sure you walk every day to reduce abdominal discomfort and help your bowel movements stay normal. Do not lift anything that is heavier than twenty pounds. You can shower, but keep the incision clean and dry. The steri-strips are removed one week after you are discharged. If you have any signs of infection, such as greater than a 100-degree temperature for more than 24 hours, swelling, tenderness, redness, or unusual drainage from your incisions, or nausea, vomiting, or shaking chills—call your surgeon. And even if you don’t experience these symptoms of infection, make sure you schedule a follow-up care appointment with your surgeon. Most patients take 1 or 2 weeks to recover from minimally invasive adrenal surgery; if you have open surgery, you will take around 5 or 6 weeks to heal.
If your condition requires advanced treatments beyond your general surgeon’s expertise, your surgeon may refer you to a surgeon with more specialized training.
However, many general surgeons go on to get additional board certifications in surgical specialties including pediatric surgery, bariatric surgery, vascular surgery, gynecology, and urology, just to name a few.
Additionally, a general surgeon can recognize and provide surgical and non-surgical treatment of a multitude of conditions related to management of pain, weight loss, geriatrics and chronic diseases.
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