Life After an Adrenalectomy

Adrenalectomy is the removal of one or both of the body's adrenal glands, which are triangular in shape and situated at the top of each kidney. Roughly one-half inch in height and three inches wide, these glands are responsible for the production of several hormones, including epinephrine, adrenaline (also known as norepinephrine), cortisone and aldosterone. This procedure can be accomplished either through open surgery or by laparoscopic means.

Your doctor may decide that a unilateral or bilateral adrenalectomy is indicated if you have any hormone disorder that can be traced to the adrenals. Such disorders are sometimes caused by tumors---benign or malignant---of the adrenal glands. Such masses may be found in one or both parts of the adrenal gland, each of which is responsible for the production and regulation of specific hormones. These two parts are the adrenal cortex, the outer layer of the gland, and the adrenal medulla that forms the core of the gland. One such hormonal disorder, Cushing's syndrome, is characterized by overproduction of ACTH (adrenocorticotropic hormone) or cortisol. Another disorder is pheochromocytoma, an adrenal tumor (90 percent of which are benign) that results in excessive levels of epinephrine or adrenaline.

The time it takes to recover from an adrenalectomy depends on the type of surgery that is performed. Traditional open surgery accesses the adrenal gland(s) through an incision just under the rib cage or in the center of the abdomen. This surgical approach is generally preferred if the entire gland or a very large portion of the gland is to be removed. Laparoscopic surgery can be accomplished with three or four much smaller incisions through which to insert a scope and other surgical implements. Recovery from open surgery usually takes four to six weeks, while recovery from a laparoscopic surgery may takes only seven to ten days.

As with all surgeries, certain complications could occur in the days immediately following the adrenalectomy. The general post-surgical dangers include excessive bleeding, slow healing, infection, blood clots in the legs, fluid retention, pneumonia or adverse reaction to anesthesia. Complications related specifically to the adrenal gland include unwanted changes in blood pressure, hormonal imbalances and Nelson's syndrome, characterized by rapid growth in a pre-existing pituitary gland tumor that could lead to skin discoloration and blood hormone level abnormalities.

Because at least one adrenal gland has been removed, your doctor may put you on some sort of steroid medication to make up for those steroid hormones that the adrenal glands would normally produce. You must have blood hormone levels closely monitored so that medication adjustments can be made if necessary.

Most patients fare well after either a unilateral or bilateral adrenalectomy. You may, however, need to take hormone supplements for the rest of your life. A 10-year study of roughly 40 Cushing's disease patients who had undergone a bilateral adrenalectomy showed that most enjoyed an improved quality of life after the surgery. The study, published in a 2007 article in Annals of Surgery, found that almost 90 percent of those studied reported a significant improvement in their Cushing's-related symptoms.