Adrenal Gland Surgery

Dr. Kolachalam, Adrenal Gland Surgery (Adrenalectomy) 

 

What is the Adrenal Gland, and what does it do?

 

The adrenal glands are small yellow glands that sit on top of the kidneys in the retroperitoneum (i.e. the deepest part of the abdomen). The adrenal glands have two layers: the cortex and the medulla. The adrenal gland is like a peanut butter sandwich where the peanut butter is the medulla and the cortex is the bread. Each layer in this sandwich makes different hormones.

The adrenal glands are responsible for making hormones that control blood pressure and respond to physical stress (fight or flight response), and still others that make us male and female.

Too many hormones (e.g. excessive cortisol, also known as Cushing’s syndrome, or aldosterone producing tumor, also known as Conn’s syndrome) or  Too few hormones (adrenal insufficiency, also known as Addison’s disease) can be fatal and patients must take medications to supplement their high or low hormone levels.

 

What hormones does the Adrenal Gland make?

 

The adrenal gland makes a number of different hormones. There are 2 layers to this gland that make this gland pack a serious punch to how your body looks, feels and responds to the environment. These 2 layers are the cortex (outside) and medulla (inside).

The outer layer – cortex – produces:

  • Mineralocorticoids (e.g. aldosterone)
      • help regulate blood pressure and potassium
      • Too much aldosterone can lead to high blood pressure and dangerously low potassium levels.
  • Glucocorticoids (e.g. cortisol)
      • help regulate blood pressure and adjust the body’s response to stress
      • Excess Cortisol can lead to Cushing’s syndrome, obesity, diabetes, high blood pressure, weak muscles, characteristic bodily changes, and brittle bones.
  • Sex steroids (e.g. testosterone and progesterone)
      • help give us the features that make us men or women
      • Too much testosterone can lead to females developing male characteristics (e.g. deeper voice, increased body hair).

 

The inner layer – medulla – produces:

  • Catecholamines (e.g. epinephrine, also known as adrenaline, and norepinephrine, also known as noradrenaline).
      • helps the body respond to stress by controlling our “fight or flight” response, and affect blood pressure
      • Too much adrenaline can lead to high blood pressure, a heart attack, or stroke.

 

What makes Aldosterone so important?

 

Aldosterone affects: sodium, potassium, total fluid in the body, and blood pressure.

Aldosterone causes: the kidneys to hold onto more sodium, which leads to more water staying in the body. The more fluid the body holds onto, the higher the blood pressure may become.

  • Potassium may decrease as the amount of aldosterone increases.
  • Aldosterone also directly affects the heart and blood vessels.

 

What makes Cortisol so important?

 

Cortisol, a steroid, has three main functions.

  1. It causes the liver to produce sugar and causes break down of muscle and fat to create this sugar.
  2. Helps the body regulate its response to stress.
  3. Decreases inflammation and decreases the immune system response.

Excess Cortisol can lead to Cushing’s syndrome, obesity, diabetes, high blood pressure, weak muscles, characteristic bodily changes, and brittle bones.

 

What cause excessive cortisol?

 

Depending on the cause of your excess of cortisol, medical or surgical treatment may be appropriate.

Common causes of too much cortisol is:

  • Taking medications that contain cortisol (medications for inflammation, skin disorders, and auto-immune problems)
  • Chronic stress
  • Chronic alcohol use
  • Chronic caffeine use

To get your cortisol levels down you can get into a routine of regular exercise, healthy attitudes and approaches to dealing with stress. Include moderation of alcohol and caffeine intake to lower your cortisol level.

Try these lifestyle changes before opting to remove one and sometimes both of the adrenal glands can take care of excess cortisol levels. Removal of one or both adrenal glands is indicated when an adrenal gland tumor is present.

 

How do I know I need surgery?

 

With the use of CT scans and MRI, Dr. Kolachalam can find small adrenal tumors (generally less than four centimeters in size).

Most small adrenal tumors, unless they have suspicious imaging features, do not need to be removed. Dr. Kolachalam will want to obtain blood and/or urine tests to make sure the tumor is not producing excess hormones. You should also receive age-appropriate health screening to ensure that a small adrenal tumor is not a cancer that has spread from somewhere else (metastasis).

A repeat CT scan or MRI should be obtained six to twelve months after your first scan to make sure the tumor is not getting bigger.

 

After Surgery: Adrenalectomy

 

  • After laparoscopic adrenalectomy, many patients may be discharged from the hospital as early as the day after surgery.
  • After open adrenalectomy, the hospital stay is longer and averages 4-5 days.
    • The ability to eat may be delayed for several days after open adrenalectomy until the bowels start moving again.
    • The overall recovery time for open adrenalectomy is significantly longer than for laparoscopic surgery.
    • Drains are more often required after open adrenalectomy than after laparoscopic adrenalectomy.

Patients may shower 48 hours after surgery. Heavy lifting or vigorous activity should be avoided for at least 4 weeks to decrease the chance of wound complications and formation of a hernia, but patients will be encouraged to get up and walk as soon as possible.

 

What about drains? Will I need one?

 

Patients rarely require drains after adrenal surgery; however, if Dr. Kolachalam thinks it is necessary, an abdominal drain will be placed.

Drains are relatively easy to take care of, and the output is recorded on a daily basis. Once the output decreases to a certain level, the drain will be removed. Removal of the drain is not particularly painful. It is more of a strange sensation. In general, the drain will be removed several days after surgery.

 

Effects of having one or both adrenal glands removed

 

Adrenal insufficiency is a potentially life-threatening complication that may occur in patients who had surgery for Cushing’s syndrome or Cushing’s disease, or who had both adrenal glands removed if not enough cortisol is produced for the body after surgery. Patients may need steroid medications.

Symptoms of this condition include:

  • Feeling generally unwell
  • Nausea
  • Vomiting
  • Confusion.

 

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