Adrenal Gland Surgery

Adenal Incidentalomas & Adrenals Surgery

Adrenal incidentalomas are adrenal lesions ≥1 cm identified incidentally on imaging performed for unrelated indications. They are found in approximately 3–4% of all abdominal computed tomography (CT) scans. It’s important to evaluate these incidental adrenal lesions to determine what treatment, if any, is needed and when specialist referral may be necessary.

Adrenal surgery is typically performed for benign/functional or malignant tumours of the adrenals.

Adrenals – the organ

Adrenal glands, also known as suprarenal glands, are small, triangular-shaped glands located on top of both kidneys. Adrenal glands produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions.

Adrenal glands are composed of two parts — the cortex and the medulla — which are each responsible for producing different hormones. When adrenal glands don’t produce enough hormones, this can lead to adrenal insufficiency (Addison’s disease). Adrenal glands may develop nodules that can be benign or malignant, which can potentially produce excessive amounts of certain hormones leading to various health issues.

What are adrenal adenomas?

An adrenal adenoma is a benign (noncancerous) tumour that forms in your adrenal glands. It’s the most common type of adrenal gland tumour. Most adrenal adenomas do not produce symptoms or require treatment. However, some adenomas may cause your adrenal glands to secrete excess hormones, like cortisol.

Can an adrenal adenoma become cancerous?

Adrenal adenomas can become cancerous, but this is rare. The most common cancerous tumour that forms in your adrenal glands is adenocorticol carcinoma. Only about 1 in 1 million people develop adrenocortical carcinoma. The majority of adrenal tumours are benign (noncancerous).

Should I have surgery for adrenal adenomas?

You may need surgery (adrenalectomy) to remove an adrenal gland if the tumor is producing excess hormones or is large in size (more than 4-6cm). If you have a cancerous tumour, you also may need an adrenalectomy. You may also need an adrenalectomy to remove cancer that has spread from another location, such as the kidney, colon cancer or lung.

What approaches are there to adrenal surgery?

Open adrenalectomy – undertaken through a long oblique incision in the right or left upper quadrant (depends on which adrenal gland is removed). This approach is reserved for large cancer.

Laparoscopic trans-peritoneal adrenalectomy – using small incisions and a tiny video camera to view the adrenal. This type of surgery can often mean a faster recovery and is the standard approach that our specialist surgeon adopts when performing adrenal surgery.

What is recovery like after adrenal surgery?

Most adrenal surgery can be performed laparoscopically. The recovery is relatively quick. You will stay in hospital for 1-2 days after the surgery. If open surgery is required, you will likely stay for 3-5 days.

If both adrenal glands are removed, you'll need to take hormone medications. If only one gland is removed, the remaining gland will take over.