Adrenalectomy in Amman: Doctors and Clinics

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.