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Obesity, weight gain, adrenal tumors and surgery

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This blog post will touch on the sensitive but very important topic: obesity, weight gain, adrenal tumors, and surgery.

Multiple times per week, I have patients ask me:

  • Can I have an adrenal operation (Mini Back Scope Adrenalectomy; MBSA) despite my size?
  • Do I need to lose weight before the operation?
  • My body mass index (BMI) is more than 50, do I need to have bariatric surgery before my adrenal surgery?

So, let's address these answers and more!

Obesity, weight gain, adrenal tumors and surgery

Weight gain and obesity are very common, including in our adrenal tumor patients

Weight gain, overweight, obesity and morbid obesity are very common. The degree of obesity is based on the body mass index (BMI). Figure 1 shows how the body mass index is calculated.

A person with a BMI of over 30 is regarded as obese and those with a BMI over 50 have super obesity.

Table 1 demonstrates the current classification of weight and degrees of obesity.

Adrenal tumors overproducing hormones can cause weight gain and obesity

Read Dr. Rhode's article where he goes in depth about how adrenal tumors overproducing hormones can cause weight gain and obesity.

Cushing’s and subclinical Cushing’s syndromes is caused by cortisol over-production from an adrenal tumor.  One of the most common universal features of the excess cortisol is weight gain, typically involving the face, neck, or belly. Often, the legs tend to lose fat, and become very slender. Fat can also be distributed in the cheeks creating a “moon face” appearance.  A hump can occur over the back of the neck due to fat distribution.  Fat can also accumulate over the collar bones resulting in a short and wide-appearing neck. 

Learn more about Cushing’s syndrome symptoms, diagnosis, and treatment.

Less well known is the fact that Conn’s syndrome (Primary hyperaldosteronism) also can cause weight gain.  The link between aldosterone, obesity, and weight gain has been studied in detail.  Aldosterone levels are already elevated in obese individuals (without and adrenal tumor).  In fact, aldosterone protects fat.  Fat cells can stimulate aldosterone release from adrenal tissue.  Thus, with an aldosterone-producing tumor, a vicious cycle of weight gain is created.

Learn more about Conn’s syndrome (primary hyperaldosteronism) symptoms, diagnosis, and treatment.

Weight gain and obesity and how it relates to adrenal surgery

You probably know at this point that the best adrenal operation, by far, is the Mini Back Scope Adrenalectomy (MBSA). 

You probably also know that there are eight different ways and approaches to perform adrenal surgery.

Weight gain, and obesity factor in with all surgery and especially surgery that involves the abdomen. Especially for inexperienced surgeons, the higher the BMI of the patient the more challenging the operation is. For the Mini Back Scope Adrenalectomy (MBSA) the key information is the distance from the skin to where the adrenal gland is. As you can imagine, the more fat a patient has the longer the distance is from the skin to the adrenal gland.

Let us review the CT scan of three recent patient (all women) who all had a successful adrenal surgery with Dr. Carling.

Patient 1. Height 5’2’’ (157 cm), 100 lbs (45 kg), BMI 18. Distance from skin to adrenal tumor = 49 mm

Patient 2. Height 5’5’’ (165 cm), 250 lbs (113 kg), BMI 41. Distance from skin to adrenal tumor = 130 mm

Patient 3. Height 5’3’’ (160 cm), 260 lbs (113 kg), BMI 46. Distance from skin to adrenal tumor = 141 mm

As you can understand, the further the distance from the skin to the adrenal gland, the less maneuverability, and more torque on the instruments during the operation. This is true for any operation going through the belly, as well.

Learn why you should not have your adrenal operation performed through the belly.

Learn why you should not have your adrenal operation performed with a robot. 

Should I lose weight before the adrenal operation?

If your BMI is greater than 40 it is a good idea to plan to lose about 10 to 20 pounds before your adrenal operation. Realistically, this can be achieved in a few weeks to a couple of months.

You are still a great candidate for the Mini Back Scope Adrenalectomy (MBSA). However, losing some weight before the operation will enable you to get mobile much quicker, and recover in a much better fashion. It will help ensure that your operation I a great success. Then after the operation, you are likely to lose more weight as the bad tumor is gone!

Special considerations for adrenal surgery in patents with BMI>50

For patient with a BMI greater than 50, special considerations sometimes need to be taken. These patients (if they have Cushing’s syndrome) sometimes benefit from medical treatment such as Korlym before their operation. Occasionally, having bariatric surgery such a sleeve gastrectomy may be beneficial prior to adrenal surgery. It all depends on a number of factors and a personalized, individualized approach is very important for these patients.

Weight gain and thyroid and parathyroid problems

Changes in your weight can also be related to thyroid disease or parathyroid disease.

Additional Resources: 

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Author

Dr. Tobias Carling MD, PhD, FACS

Dr. Carling is the most experienced adrenal surgeon in the United States, and by far the world's most knowledgeable surgeon-scientist when it comes to adrenal gland function and disease, adrenal tumors and cancer, and all forms of adrenal gland surgery. Dr. Carling has more experience with advanced minimally invasive adrenal and endocrine operations than any surgeon in the United States. A fellow of the American College of Surgeons, Dr. Carling is a significant member of both the American Association of Endocrine Surgeons (AAES) and the International Association of Endocrine Surgeons (IAES).