Adrenalectomy is the surgical removal of one or both adrenal glands — two small glands sitting above the kidneys that produce cortisol, aldosterone and the stress hormones adrenaline and noradrenaline. The aim is either to stop excess hormone production coming from a tumour within the gland, or to remove a mass that is large or radiologically suspicious. The commonest indications are functioning tumours: an aldosterone-producing adenoma causing hypertension that is difficult to control together with low potassium; a cortisol-producing adenoma causing Cushing syndrome with altered fat distribution, thin skin and raised blood sugar and blood pressure; or a phaeochromocytoma, which releases stress hormones and causes episodes of headache, sweating, palpitations and fluctuating blood pressure. Surgery is also considered for masses with suspicious imaging features, masses above a certain size, lesions that grow on surveillance, and some cancers. In most cases the operation is now performed in a minimally invasive way through small incisions, either through the abdomen or from the back behind the peritoneum, while open surgery remains necessary for large tumours, tumours adherent to surrounding structures, and cases suspicious for malignancy. Medical preparation beforehand is a substantial part of the treatment: control of blood pressure, potassium and blood sugar and, in phaeochromocytoma, a preparation period of weeks with monitoring of blood pressure, pulse, fluid and salt intake to reduce the risk of dangerous swings during anaesthesia. The limits of the operation matter in practice. Removing the gland does not necessarily cure high blood pressure: many patients improve and need fewer medicines, while some still require treatment, particularly when the disease went undiagnosed for years or another cause of hypertension coexists. It is not a weight-loss operation and not a treatment for obesity, although controlling cortisol does gradually improve fat distribution in Cushing syndrome. It is not performed for small, silent, non-functioning masses with benign imaging features, which are followed with imaging and blood tests. And after removal of a cortisol-producing gland, or of both glands, hormone replacement is needed for a period or for life. The decision to operate, and the approach chosen, is never taken from reading a page: it rests on precise hormonal testing, localising imaging, cardiac and anaesthetic assessment and clinical examination, usually as a joint decision between an endocrine surgeon and an endocrinologist.
Procedure steps
- 1
Confirming the hormonal diagnosis
Specific blood and urine tests establish whether the mass is genuinely functioning and which hormone it secretes. Suppression or stimulation tests may be required, and in selected cases blood is sampled from the adrenal veins to identify which side is responsible.
- 2
Imaging and localisation
CT or MRI defines the mass, its size and its relationship to the kidney and major vessels, with functional imaging added in selected cases. This stage determines the surgical approach that is likely to be used.
- 3
Medical preparation and anaesthetic assessment
Blood pressure, potassium and glucose are optimised; in phaeochromocytoma an extended drug preparation is undertaken with pulse and blood-pressure monitoring and the fluid and salt intake your doctor advises. Heart and lungs are assessed before general anaesthesia.
- 4
Surgical removal
Under general anaesthesia the gland is removed through small incisions from the abdomen or the back, the adrenal veins are secured carefully, and the specimen is retrieved in a protective bag. Conversion to open surgery is done whenever the minimally invasive route cannot proceed safely.
- 5
Hormonal monitoring and follow-up
Vital signs, glucose, sodium and potassium are monitored after surgery, steroid replacement is prescribed when required together with a clear sick-day plan, and hormones and blood pressure are re-measured at follow-up visits to guide gradual reduction of medication.
Before the procedure
Bring a complete list of your medicines and supplements, and tell the team specifically about blood pressure and diabetes medication, blood thinners and aspirin, and any steroid you have taken in recent months in any form. Do not stop any medicine on your own: some antihypertensives are held before surgery and others must be continued, and that decision belongs to your doctor. Report pregnancy or possible pregnancy, drug allergies, any previous problem with anaesthesia, heart or lung disease, and sleep apnoea. Expect blood tests, imaging and a pre-operative assessment, and a fasting period defined by the anaesthetic team. Stop smoking as far in advance as possible, arrange someone to accompany you and help at home after discharge, and ask in advance whether you will need steroid replacement and how to manage it.
After the procedure
Expect discomfort at the port sites and shoulder-tip pain from the gas used in laparoscopy, both of which settle over days, and expect to be encouraged to walk early and to do breathing exercises to reduce the risk of clots and chest infection. Attend for the blood pressure, glucose and potassium checks you are asked to have, and do not restart your former antihypertensive doses without your doctor's decision — after surgery they may be more than you need and can cause low pressure. If steroid replacement is prescribed, the most important rule is: **never stop it on your own and never skip doses; increase the dose exactly as your doctor has taught you during fever, diarrhoea, vomiting or severe physical stress, and carry a card stating that you take steroid replacement.** **Seek emergency care immediately for: profound weakness, dizziness, fainting or low blood pressure; repeated vomiting or diarrhoea preventing you from taking medication; severe abdominal pain; fever or chills; redness or discharge from the wound; breathlessness or chest pain; or swelling and pain in one leg.**
Expected duration
Typically one and a half to three hours laparoscopically, longer for large tumours or open surgery, with a usual hospital stay of one to three days.
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