adrenalectomy

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Adrenalectomy

 

Definition

Adrenalectomy is the surgical removal of one or both of the adrenal glands. The adrenal glands are paired endocrine glands, one located above each kidney, that produce hormones such as epinephrine, norepinephrine, androgens, estrogens, aldosterone, and cortisol. Adrenalectomy is usually performed by conventional (open) surgery, but in selected patients surgeons may use laparoscopy. With laparoscopy, adrenalectomy can be accomplished through four very small incisions.

Purpose

Adrenalectomy is usually advised for patients with tumors of the adrenal glands. Adrenal gland tumors may be malignant or benign, but all typically excrete excessive amounts of one or more hormones. A successful procedure will aid in correcting hormone imbalances, and may also remove cancerous tumors that can invade other parts of the body. Occasionally, adrenalectomy may be recommended when hormones produced by the adrenal glands aggravate another condition such as breast cancer.

Precautions

The adrenal glands are fed by numerous blood vessels, so surgeons need to be alert to extensive bleeding during surgery. In addition, the adrenal glands lie close to one of the body's major blood vessels (the vena cava), and to the spleen and the pancreas. The surgeon needs to remove the gland(s) without damaging any of these important and delicate organs.

Description

Open adrenalectomy

The surgeon may operate from any of four directions, depending on the exact problem and the patient's body type.
In the anterior approach, the surgeon cuts into the abdominal wall. Usually the incision will be horizontal, just under the rib cage. If the surgeon intends to operate on only one of the adrenal glands, the incision will run under just the right or the left side of the rib cage. Sometimes a vertical incision in the middle of the abdomen provides a better approach, especially if both adrenal glands are involved.
In the posterior approach, the surgeon cuts into the back, just beneath the rib cage. If both glands are to be removed, an incision is made on each side of the body. This approach is the most direct route to the adrenal glands, but it does not provide quite as clear a view of the surrounding structures as the anterior approach.
In the flank approach, the surgeon cuts into the patient's side. This is particularly useful in massively obese patients. If both glands need to be removed, the surgeon must remove one gland, repair the surgical wound, turn the patient onto the other side, and repeat the entire process.
The last approach involves an incision into the chest cavity, either with or without part of the incision into the abdominal cavity. It is used when the surgeon anticipates a very large tumor, or if the surgeon needs to examine or remove nearby structures as well.

Laparoscopic adrenalectomy

This technique does not require the surgeon to open the body cavity. Instead, four small incisions (about 1/2 in diameter each) are made into a patient's flank, just under the rib cage. A laparoscope, which enables the surgeon to visualize the inside of the abdominal cavity on a television monitor, is placed through one of the incisions. The other incisions are for tubes that carry miniaturized versions of surgical tools. These tools are designed to be operated by manipulations that the surgeon makes outside the body.

Preparation

Most aspects of preparation are the same as in other major operations. In addition, hormone imbalances are often a major challenge. Whenever possible, physicians will try to correct hormone imbalances through medication in the days or weeks before surgery. Adrenal tumors may cause other problems such as hypertension or inadequate potassium in the blood, and these problems also should be resolved if possible before surgery is performed. Therefore, a patient may take specific medicines for days or weeks before surgery.
Most adrenal tumors can be imaged very well with a CT scan or MRI, and benign tumors tend to look different on these tests than do cancerous tumors. Surgeons may order a CT scan, MRI, or scintigraphy (viewing of the location of a tiny amount of radioactive agent) to help locate exactly where the tumor is.

Key terms

Laparoscope — An instrument that enables the surgeon to see inside the abdominal cavity by means of a thin tube that carries an image to a television monitor.
Pancreas — An organ that secretes a number of digestive hormones and also secretes insulin to regulate blood sugar.
Pheochromocytoma — A tumor of specialized cells of the adrenal gland.
Spleen — An organ that traps and breaks down red blood cells at the end of their useful life and manufactures some key substances used by the immune system.
Vena cava — The large vein that drains directly into the heart after gathering incoming blood from the entire body.
The day before surgery, patients will probably have an enema to clear the bowels. In patients with lung problems or clotting problems, physicians may advise special preparations.

Aftercare

Patients stay in the hospital for various lengths of time after adrenalectomy. The longest hospital stays are required for open surgery using an anterior approach; hospital stays of about three days are indicated for open surgery using the posterior approach or for laparoscopic adrenalectomy.
The special concern after adrenalectomy is the patient's hormone balance. There may be several sets of lab tests to define hormone problems and monitor the results of drug treatment. In addition, blood pressure problems and infections are more common after removal of certain types of adrenal tumors.
As with most open surgery, surgeons are also concerned about blood clots forming in the legs and traveling to the lungs (venous thromboembolism), bowel problems, and postoperative pain. With laparoscopic adrenalectomy, these problems are somewhat less difficult, but they are still present.

Risks

The special risks of adrenalectomy involve major hormone imbalances, caused by the underlying disease, the surgery, or both. These can include problems with wound healing itself, blood pressure fluctuations, and other metabolic problems.
Other risks are typical of many operations. These include:
  • bleeding
  • damage to adjacent organs (spleen, pancreas)
  • loss of bowel function
  • blood clots in the lungs
  • lung problems
  • surgical infections
  • pain
  • extensive scarring

Resources

Books

Fauci, Anthony S., et al., editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1997.

adrenalectomy

 [ah-dre″nah-lek´tah-me]
surgical excision of an adrenal gland, done when a disorder of the adrenal gland, such as cushing's syndrome, pheochromocytoma, or adrenal adenoma or carcinoma causes an overproduction of adrenal hormones. In some instances of severe Cushing's syndrome, total bilateral adrenalectomy is done.

a·dre·nal·ec·to·my

(ă-drē-năl-ek'tŏ-mē),
Removal of one or both suprarenal glands.
[adrenal + G. ektomē, excision]

adrenalectomy

(ə-drē′nə-lĕk′tə-mē)
n. pl. adrenalecto·mies
Surgical excision of one or both of the adrenal glands.

adrenalectomy

[ədrē′nəlek′təmē]
Etymology: L, ad + ren; Gk, ektomē, excision
the total or partial surgical resection of one or both adrenal glands. It is performed to reduce the excessive secretion of adrenal hormones caused by an adrenal tumor or a malignancy of the breast or prostate. The incision is made under the twelfth rib in the rear flank area with the patient under general anesthesia. Preoperative laboratory tests include electrolytes, fasting blood glucose, glucose tolerance, and fluid states and adrenergic and blockade if needed. Hemodynamic monitoring and preoperative steroid replacement are needed. Before surgery a nasogastric tube may be inserted. Careful intraoperative positioning is necessary for the patient with Cushing's syndrome because of osteoporosis, fragile bones, and muscle wasting. In patients with pheochromocytoma, intraoperative manipulation of an adrenal tumor can cause a surge of catecholamines, resulting in a blood pressure increase. Postoperative care focuses on maintaining blood pressure with vasoconstrictors or vasodilators as needed, giving replacement doses of corticosteroids, and monitoring fluid and electrolyte status. When both glands are removed, the maintenance dosage of steroids continues for life. Stress and fatigue must be avoided. See also Addison's disease, Cushing's syndrome.

Adrenalectomy

The surgical excision of one or more adrenal glands, which is performed for adrenal tumours and was, for a time, performed in patients who had oestrogen receptor positive breast cancer. Bilateral adrenalectomy mandates lifelong supplementation with cortisone and hydrocortisone.

adrenalectomy

 Removal of the adrenal glands

ad·re·nal·ec·to·my

(ă-drē'năl-ek'tŏ-mē)
Removal of one or both suprarenal glands, total or partial. Preoperative steroid replacement therapy may be required.
[adrenal + G. ektomē, excision]

ad·re·nal·ec·to·my

(ă-drē'năl-ek'tŏ-mē)
Removal of one or both suprarenal glands, may be total or partial. Preoperative steroid replacement therapy may be required.
[adrenal + G. ektomē, excision]

adrenalectomy (ədrē´nəlek´təmē),

n the surgical removal of one or both of the adrenal glands or the resection of a portion of one or both of the adrenal glands.

adrenalectomy

surgical excision of an adrenal gland. This procedure is indicated when a disorder of the adrenal gland, such as cushing's syndrome or pheochromocytoma, causes an overproduction of adrenal hormones.
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The effects of adrenalectomy in the psychic sphere of patients has been studied since adrenalectomies were more in number.
I enjoyed doing the Whipple procedure and adrenalectomies.
Most laparoscopic adrenalectomies are performed via a transperitoneal approach with the patient in a 90 degree lateral position.