Adrenal Surgery

What are the Adrenal Glands and what do they do?

The adrenal glands are small, pyramidal shaped organs which sit on top of the kidneys. They produce hormones that are very important for the healthy function of your body. The adrenal medulla makes adrenaline and other related hormones which you need for the ‘fight or flight’ response. The cortex makes several hormones including aldosterone which is an important hormone for controlling blood pressure and your body’s salt levels. It also makes the hormone cortisol which is an important ‘stress hormone’. Small amounts of sex hormones are also made by the adrenal but these are not usually of any significance in the context of adrenal nodules.

Why might I need adrenal surgery?
If adrenal surgery is usually recommended it is usually for one of two reasons:

• Overproduction of hormones (we call these nodules ‘functional’). When the cause of the excessive hormone production is the adrenal nodule these conditions are given certain medical names:
  - Too much adrenaline = Phaeochromocytoma (Fee-oh-chrome-oh-cytoma)
  - Too much aldosterone = Conn’s syndrome
  - Too much cortisol = Cushing’s syndrome
• Size. The bigger an adrenal nodule is the greater the risk is that the lump might be cancerous. Adrenal cancer is very rare and only occurs in about 1 in 1,000,000 New Zealanders per year.

I will fully assess your adrenal nodule to decide if it is functioning or if there is a risk of cancer.

What types of adrenal surgery are there?
To treat an adrenal nodule it is normal to remove the entire adrenal gland. For all types of adrenal surgery you will require a general anaesthetic and will be fully asleep. Most adrenal glands can be removed by a minimally invasive ‘keyhole’ technique. The optimal way of removing benign adrenal problems 4-6cm or less is via an operation called a posterior retroperitoneoscopic adrenalectomy. When the adrenal mass is larger a trans-abdominal lapraroscopic adrenalectomy or an open adrenalectomy is normally required.

• Postetrior Retroperitoneoscopic Adrenalectomy (PRA): This is a relatively modern technique used to remove adrenal glands. It is associated with the least post-operative pain and the quickest recovery time of the adrenal surgery options. To remove the adrenal gland you will be placed face down and three small incisions will be made on your back. Most patients only require panadol and ibuprofen as pain relief after this type of surgery. You will typically be ready to go home on the morning after surgery but if your adrenal gland was making too much cortisol before the operation you will normally stay in hospital a little longer so that we can monitor you.
• Laparoscopic Transabdominal Adrenalectomy: Larger benign adrenal nodules, up to about 8cm, can still be removed by keyhole surgery. Recovery from this type of adrenal surgery is usually very quick. Like the PRA most patients can go home the day after surgery.
• Open Adrenalectomy: For the largest adrenal masses or when there is a high suspicion of adrenal cancer the safest way to remove the adrenal gland is with an open operation. This is a big operation and you will need to stay in hospital for up to a week but it is the safest way to remove such large adrenal problems.