Adrenalectomy

What is an adrenalectomy?

Medically speaking, an adrenalectomy is a surgical procedure to remove one or both adrenal glands (also known as the suprarenal glands). This surgery may be necessary when a large tumor affects the gland.

There are two types of adrenalectomy procedures: a partial adrenalectomy, where only part of the adrenal gland is removed, and a total adrenalectomy, which involves the complete removal of the gland. If both adrenal glands are removed, the procedure is referred to as a bilateral adrenalectomy.

According to German hospital statistics from 2018, approximately 3,600 partial or total adrenalectomies were performed in German hospitals that year. In comparison, nearly 200,000 gallbladder removals were conducted, highlighting that adrenalectomy is a relatively rare and specialized surgical procedure that should be performed by highly specialized surgeons.

The adrenal gland: structure and function

The paired adrenal glands are located on top of the two kidneys and are small organs that are responsible for producing hormones. Since these hormones are released directly into the blood, the adrenal glands are also known as endocrine organs.

Each adrenal gland can be divided into a cortex and an inner medulla, each of which performs different functions.

• The adrenal cortex

There are three main hormones produced in the adrenal cortex. All of them are derived from the shared precursor cholesterol. In the outermost layer of the cortex, mineralocorticoids are synthesized, the most well-known of which is aldosterone. This hormone primarily acts on the kidneys to help regulate water and electrolyte balance.

Glucocorticoids are produced in the deeper layer, with cortisol being the most significant. Cortisol is a hormone which is released primarily in stressful situations and sets the whole body on alert. This mobilizes energy reserves, for example, or increases blood pressure and heart rate in order to cope with stressful situations.

The innermost layer of the adrenal cortex produces sex hormones, which are further converted in other organs to testosterone or estrogen. Compared to the primary sources of male and female sex hormones, the adrenal cortex plays a relatively minor role in this regard.

• The adrenal medulla

The adrenal medulla produces catecholamines, which includes adrenaline (epinephrine), noradrenaline (norepinephrine) and dopamine. Noradrenaline and dopamine act mainly as neurotransmitters in the body and allow for communication between neurons.

Adrenaline works similarly to cortisol from the adrenal cortex as a hormone that is secreted in physical and psychological stress situations. Its release works mainly to maintain circulatory function, which is why adrenaline has important applications in emergency and intensive care medicine. 

When is an adrenalectomy necessary?

An adrenalectomy may be necessary for certain tumors of the adrenal cortex, requiring partial or complete removal of the gland. Since the adrenal cortex synthesizes important hormones, an adrenalectomy should only be performed when there is a clear medical indication.

Generally, hormone-producing tumors in the adrenal cortex or medulla, as well as tumors larger than 4 centimeters should be removed. In many cases, a partial or total adrenalectomy is necessary.

The most significant hormone-producing tumors of the adrenal cortex cause either Cushing’s syndrome or Conn’s syndrome. In both cases, adrenalectomy may be a suitable treatment.

Cushing’s syndrome is characterized by elevated cortisol level and typically develops as a result of long-term therapy with cortisol-based medications. It can, however, also be caused by a hormone-producing tumor in the adrenal cortex. Symptoms include high blood pressure, central obesity, and osteoporosis.

Conn’s syndrome is associated with an increased concentration of aldosterone. Often this causes electrolyte imbalances as well as high blood pressure that is difficult to regulate. In about 30% of cases, there may be low potassium level which may cause muscle weakness, constipation, or ECG changes.

A hormonally active tumor of the adrenal medulla is called a pheochromocytoma. The specific symptoms result from the uncontrolled production of catecholamines. Affected individuals often experience recurring hypertensive crises, rapid heart rate, sweating, headaches, and restlessness.

Furthermore, there are non-hormone-producing tumors of the adrenal cortex. These are removed once they reach a certain size, while smaller tumors should be regularly monitored. The exception is malignant tumors (carcinomas), which should be surgically removed in all cases.

How is the surgery performed?

An adrenalectomy is usually done during a short hospital stay of about three to five days. Prior to the surgery, it is important to assess the tumor's hormonal activity, especially in cases of pheochromocytoma, as specific preparations are required for this type of tumor.

To prevent a potential blood pressure crisis after the surgery, patients with pheochromocytoma must take specific medications. These block specific receptors, which in turn helps keep blood pressure stable in the case that there is a large release of hormones during the surgery.

The adrenalectomy is performed under general anesthesia and usually takes less than an hour. In the majority of cases, the operation is done using a minimally invasive technique known as laparoscopy, which only requires small skin incisions through which the surgical instruments are inserted.

Rarely, the surgery is performed as an open operation, which requires larger incisions to provide optimal access to the surgical area. This can be done in the case of a malignant or very large tumor removal, for example.

After the procedure, the patient wakes up from anesthesia and remains in the hospital for a few nights for monitoring. Follow-up treatment is generally done on an outpatient basis.

What are the possible risks & complications of the surgery?

Like with any surgery, an adrenalectomy carries certain risks. These include bleeding, infections, wound healing disorders or injury to surrounding organs. However, thanks to the minimally invasive technique, these risks can be minimized.

As the adrenal glands are hormone-producing organs, their vital function must be substituted. The extent to which the hormones of the adrenal gland need to be externally supplemented depends on whether there is any residual activity. In the case of a complete bilateral adrenalectomy, the patient must always take cortisone. Electrolyte levels should also be checked regularly.

Aftercare and prognosis

Aftercare following an adrenalectomy includes routine monitoring of the wound site and the patient’s overall condition, as with any surgery. However, in the case of adrenalectomy, particular emphasis is placed on monitoring hormone levels, as this is critical for the prognosis.

For patients with a pheochromocytoma, adrenalectomy is often highly effective, and blood pressure usually returns to normal. If the surgery addresses the underlying cause of Cushing's or Conn's syndrome, the prognosis is also very good, provided hormone levels are closely monitored.

Adrenal carcinomas can be effectively treated with adrenalectomy if detected at an early stage. However, in advanced stages, the five-year survival rate is below 40%. In such cases, chemotherapy may be necessary in addition to surgery or as a standalone treatment.

Which doctors & clinics specialize for adrenalectomy?

An adrenalectomy requires careful handling to minimize the risk of complications during and after the procedure. Specialists for adrenalectomy are general or visceral surgeons with a focus on endocrine surgery.

The outcome of adrenal gland surgery largely depends on the surgeon's expertise and experience. Therefore, all doctors listed here have been carefully vetted and selected. Each is an expert in their field, specializing in adrenalectomy.

Schedule an initial appointment with one of our specialists quickly and easily, and receive direct, personalized advice.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of adrenalectomy. They are looking forward to and are ready to address your questions and treatment requests.