Medicine

Patient information

Having an Adrenalectomy

A guide for patients who have been recommended surgery to remove their adrenal glands

What are the adrenal glands?

The human body has 2 adrenal glands located on top of each kidney. They are a very important part of the endocrine system – the series of glands throughout the body that regulate vital body functions through a controlled release of hormones.

The main functions of the adrenal glands hormones include balance of fluid and salt in our cells, maintenance of blood pressure, and management of stress and shock.

Two vital hormones that the adrenal glands produce are called cortisol and aldosterone.

What are the benefits of having an adrenalectomy?

An adrenalectomy is the surgical removal of one or both of the adrenal glands and is an effective way to control particular, and often complicated, conditions.

Adrenal gland tumours can affect the way that hormones are released from one or both of your adrenal glands and this can make you feel very unwell. Most adrenal tumours are benign (not cancerous) but this diagnosis can be difficult to make without surgical removal. Removal of the tumour can treat an adrenal condition and provide information as to what type of tumour it is, and if further management is needed.

An example of an adrenal tumour is a phaeochromocytoma, which causes the body to make too much adrenaline. This type of tumour can cause very high blood pressure.

There are also particular conditions that can be treated and controlled by removing the adrenal glands, such as Cushing’s syndrome (whereby the body makes too much cortisol), and Conns syndrome (a condition whereby the adrenals produce too much aldosterone).

How does the team decide that surgery is the best option for me?

All patient cases are presented at the multi-disciplinary team (MDT) meeting where the clinicians will consider if you would likely benefit from adrenal surgery. The recommendations made by the MDT will be discussed with you by your doctor.

Are there any alternatives to surgery?

Your doctors have recommended surgery as the best treatment option available to treat your condition. Should you decide that you do not want to have surgery, you can discuss with your doctor if there are other treatment options. Depending on your condition, treatment such as medication or radiotherapy might be considered but are unlikely to be as effective as surgery.

How is an adrenalectomy carried out?

There are two ways that surgery is performed. The surgeon will explain which type of procedure is right for you.

Laparoscopy

In many cases the adrenal glands can be accessed through 3-4 cuts made just below the rib cage using fine instruments guided by a laparoscope (camera). This is commonly known as ‘key-hole surgery’. Carbon dioxide gas is used to ‘inflate’ the abdomen temporarily during this technique.

 Laparotomy

Some laparoscopic operations need to proceed to ‘open’ surgery if the surgeon is not able to see inside of the abdomen clearly. In this case a large cut is made, called a laparotomy. A laparotomy may be the best option for you to begin with.

How do I prepare for surgery?

Your first visit will be with the doctor to discuss your surgery. The doctor will explain what an adrenalectomy involves, the risks and benefits of going ahead with surgery as well as any alternative options that may be available to you.

It is important that you have enough understanding to allow you to give your informed consent for the doctor to go ahead with surgery, so please do not hesitate to ask any questions. You will be asked to sign a form at this appointment which confirms your consent and understanding.

• We will advise you on medications you are currently taking.
• You should cut down or stop smoking a few weeks before surgery to help prevent related complications afterwards.
• The day before surgery you may need medicine or an enema (liquid that is gently inserted into the rectum) to clear out your bowel.
• If your surgery is close to your spleen (an organ that is part of our immune system and sits to the left of the stomach) we may give you vaccinations to help prevent infection.

What should I expect following surgery?

The first few days following surgery you should expect the following:

• You will feel bruised, and quite bloated from the surgical gas, which you will release naturally over the first few days.
• You will have control of a pain relief pump (PCA) to relieve discomfort. The pump delivers a strong pain killer through your vein. You control the pump with a button. You cannot give yourself too much pain killer because the pump will lock out after each time the button is pressed, so it is very safe.
• You may feel a bit sick. This is usually due to the general anaesthetic and does not last long. We can give you anti- sickness medicine if you need it.
• After a day or so when you are more comfortable and eating and drinking, we will start you on oral pain killers.
• You will have one or two wound drains. These are plastic bottles attached to tubes that enter your skin near your surgery sites. Drains help with healing and are usually removed after 1 or 2 days.
• You may have a catheter (tube in your bladder) that allows your urine to drain into a bag until you are up and about and able to use the toilet.
• It is quite common to get constipated following surgery. We can give you some medicine to help you open your bowels without straining. When advised by your surgeon, you can introduce fibre, fruit and vegetables into your diet and increase your water intake to help prevent constipation.
• We encourage patients to move around quite soon after surgery, to help promote a good recovery.
• Surgery sites are usually closed with dissolvable stitches, which do not need to be removed.
• You can have a shower as soon as you feel able to do so, ideally once the drains and catheter have been removed, so that you do not accidentally pull on any tubing whilst bathing. It is ok if you get your surgery dressing a little damp, but  get it changed if it becomes soggy, to help prevent infection.

How long will I be in hospital for?

The average length of stay in hospital is about 2-4 days following a laparoscopic procedure, and around 5-7 days after a laparotomy.

What are the risks of surgery?

Whilst not common, your surgeon will describe the main risks of having a general anaesthetic and surgery to you as follows:

• Infection (e.g. chest, urine, surgery sites).
• Bleeding from the surgery sites.
• Forming a blood clot in the leg that can move to the lungs.
• Damage to nearby blood vessels or organs (such as the spleen) in the body.

Every effort is made to prevent complications, but if they do happen, they can be treated.

Will I need to take hormone replacement therapy?

If you have just one of your adrenal glands removed then generally you will not need to have hormone replacement therapy because the other gland will ‘take over’ and make the right amount of hormones your body needs.

If you have had both adrenal glands removed you will start hormone replacement therapy immediately after surgery. This is essential and a lifelong treatment. There are 2 hormones that need replaced:

Cortisol in the form of hydrocortisone

Cortisol controls glucose production and inflammatory responses in the body. So cortisol is essential for life and protects the body when under physical stress, such as during illness or following an injury.

Aldosterone in the form of fludrocortisone Aldosterone maintains blood pressure by controlling the

amount of fluid that the body holds onto. Aldosterone makes

the kidneys hold onto more sodium, which leads to increased total body fluid. The more fluid the body holds onto, the higher the blood pressure will be.

How do I take these hormones?  

Both hormones are taken by mouth in the form of small tablets and need to be taken at the right time of day, every day. It is very safe to take hormone replacement if taken correctly.

We will explain how to take hormone replacement in detail and give you information to take away with you.

It is very important that you understand how to take your hormone replacement therapy before you leave the hospital. That way, you can get into the routine of taking them before you go home.

What clinic appointments will I need?

You may not need a surgical follow up appointment. Your doctor will discuss this with you and we will make the necessary arrangements as needed.

It is likely that you will need endocrine clinic follow-up. If you have started hormone replacement therapy, we will arrange blood tests in our day unit at regular intervals to make sure you are on the right doses.

Large print and other languages

This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

Tell us what you think

Tweet us @NHSBartsHealth
Talk to us via facebook.com/bartshealth
Leave feedback on NHS Choices www.nhs.uk

Reference: BH/PIN/910

Publication date: Feb 2021

All our patient information leaflets are reviewed every three years.