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Adrenal Tumors

Tumors of the adrenal glands can be either malignant (cancer) or benign (non-cancer). These tumors can cause different symptoms.

Some patients are diagnosed with primary hyperaldosteronism. In 80% of these patients it is caused by an adenoma (benign tumor) in the adrenal cortex that releases too much aldosterone. Symptoms may include high blood pressure, low blood potassium levels and muscle weakness.

Cushing’s syndrome, or an excessive production of glucocorticoids, is also caused by an adrenal cortex tumor. Symptoms may include moon face (round, puffy face), buffalo hump (an increase in fat pads just below the back of the neck), truncal obesity (increase in weight around the abdomen), wasting of your muscles, easy bruising, facial hair, purplish “stretch marks” on your abdomen, high blood pressure and changes in emotions from feelings of high to low.

Another type of adrenal tumor is called a pheochromocytoma. Pheochromocytomas are usually located in the adrenal medulla. About 85- 90 % occur at random, but some may occur in families. Symptoms can include headache, sweating, palpitations (rapid heart beats), and high blood pressure. There will also be high levels of catecholamines (epinephrine and norepinephrine) in the urine and blood.

Condition

Surgical removal of the adrenal gland (adrenalectomy) may be recommended in situations of hormone overproduction or if there is a concern that a mass of the adrenal gland may be a cancer.Three main situations exist where hormone overproduction is an indication to have an adrenalectomy. The first is Cushing's Syndrome in which excess steroid production (cortisol) is caused by a tumor of the adrenal cortex. The second is Conn's Syndrome in which a tumor of the same area produces excess aldosterone which may cause problems with high blood pressure and blood potassium levels. The third is a tumor of the medulla which is called a pheochromocytoma. This tumor may manufacture excess adrenaline and cause problems such as high blood pressure, excess sweating, tremor, and anxiety.

Sometimes an adrenal tumor is found incidentally during an ultrasound or CAT scan of the abdomen. Even if these tumors do not overproduce hormones and cause any of the problems above, adrenalectomy may be recommended due to the size or other characteristics of the mass. This is because of concern that the mass may be a cancer of the adrenal gland. Adrenal cancer is very rare, but adrenalectomy may be the only chance to cure the cancer. If the tumor is a cancer that has spread from another organ to the adrenal gland, that is not a good reason for adrenalectomy (with very few exceptions).

Treatment

Open Adrenalectomy

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Figure : An open adrenalectomy scar

This is usually performed if the adrenal tumour is very large or is likely to be a cancer. Open adrenalectomy is generally performed under a general anaesthetic. Open operations may be performed through the back, the flank, or the abdomen. In all cases a skin incision is made and the underlying muscles divided. The adrenal gland is located and removed with great care being taken not to injure nearby structures such as the major veins in the abdomen. The muscles are then put together again and the skin incision is closed with sutures that will either absorb or be removed soon after your operation.

Laparoscopic Adrenalectomy

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Figure : A laparoscopic adrenalectomy scar

This can be performed where the tumour is smaller and unlikely to be a cancer. It is also performed under general anaesthetic. Laparoscopic procedures use small telescopes and instruments to remove the adrenal gland through a number of small incisions. The adrenal gland is located and removed with video guidance and, as with open surgery, with great care being taken not to injure nearby structures such as the major veins in the abdomen. Typically, patients having laparoscopic procedures have less pain and a more rapid recovery.

Complications

Possible problems include bleeding, surgical-wound infection, adrenal-hormone shortage, fluid retention and increased risk of infections. However, serious problems are rare and patients can expect complete healing without complications. If the operation has been done with the laparoscope most patients have recovered in two to three weeks, allowing for the fact that hormone recovery can take longer, particularly in the case of cortisol-secreting tumours. If the operation has been done by an open approach you must allow about six weeks for recovery from surgery.

Risks

Heart and circulation problems such as heart attack or blood clot formation. Clots which form in the legs can move to the lungs and cause life-threatening problems. Blood clots or debris can similarly cause a stroke.

Bleeding during the operation is a possibility as the adrenal glands are adjacent attached to large arteries and veins. The need for blood transfusion is a possibility especially in operations done for large cancers of the adrenal gland.

Abnormally high or low blood pressure is a risk following removal of certain adrenal tumors and can usually be prevented or treated with medicine.

Wound infections are not common, but may be more likely in people with diabetes or steroid therapy.

Other infections such as bronchitis, pneumonia, or urinary infections can develop after a general anesthetic and operation.

Any surgical incision in the abdomen may be at risk of developing a hernia long after the operation.

Depending on the type of adrenal disorder leading to your adrenalectomy, you may require oral steroid medication to replace those steroids formally made by the adrenal gland. In some cases, these steroids are essential for life.

FAQs

Q. How long does the operation take?

Ans : Surgery itself usually lasts three to five hours. However, it generally takes five to six hours from the time you leave the pre-op area until you arrive in the recovery room. You will be unable to see your family for an additional two hours, the period most people are in the recovery room.

Q. How long will I be in the recovery room after surgery is done?

Ans : Generally, you will be in the recovery room for two hours. This may be longer depending on how readily available are the rooms on the ward.

Q. How Long Will I Be In The Operating Room?

Ans : You will be in the operating room for about 2-4 hours with at least another 1 - 2 hours in the recovery room afterwards.

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