When you have been told by your doctor that you need to see a surgeon for adrenal gland removal, several questions, and even worries, may come to mind.

Top 4 Worries for Adrenal Gland Removal:

1. Why do I need adrenal gland removal? Is it cancer?
2. Is my surgeon experienced in adrenal gland removal?
3. How will my surgeon perform my adrenal gland removal?
4. Is there a team in-place to care for me before, during, and after adrenal gland removal?

Worry #1: Why do I need adrenal gland removal? Is it cancer?

Adrenal glands are removed for 4 main reasons: non-cancerous tumors (adenomas) causing hormone over-production (functional tumors), large tumor size, a cancer from elsewhere in the body has spread (metastasis) to the adrenal gland, or cancer of the adrenal gland.  Fortunately, cancer of the adrenal gland is extremely rare.  As such, adrenal gland removal is typically offered for hormone over-producing (functional) tumors or enlarged tumor size.

Figure 1: Adrenal cancer removed by an expert surgeon. This adrenal tumor produced too much estrogen in a man leading to feminization, with breast formation.

The adrenal gland produces those hormones that participate in salt, sugar, and sex hormone metabolism, as well as adrenaline-type hormones responsible for the fight-or-flight response.  Thus, when an adrenal tumor 1 cm or greater is discovered on X-ray studies performed for another problem, blood work should be drawn to see if your adrenal gland is over-producing its hormones.  In other cases, high blood pressure, low blood potassium levels, difficulty in controlling your blood sugar, obesity, chronic headaches, palpitations, or flushing will signal to your doctor that blood work should be done to look for an adrenal tumor producing too much hormone.

When removing an adrenal gland, size matters since glands over 4 cm have a roughly 6 % risk of cancer, whereas those less than 4 cm carry a 2 % risk, or three times less likely.  Also, the way the mass looks on an X-ray study (often CT scan) such as the shape, borders, and interactions with surrounding tissue will determine if the adrenal needs to be removed.  As a general rule of thumb, adrenal tumors greater than 4 cm should be considered for removal (3 cm for younger people).  The skilled interpretation of your blood work and X-ray studies is where an experienced adrenal gland surgeon is extremely important in guiding whether adrenal gland removal is necessary.

To learn more about functional tumors requiring adrenal gland surgery, go here: https://www.adrenal.com/adrenal-gland/common-problems

To learn about X-ray studies for adrenal tumors, go here: https://www.adrenal.com/adrenal-tumors/scans

Worry #2: Is my surgeon experienced in adrenal gland removal?

A surgeon experienced in adrenal gland removal is important for two reasons: more experience = higher cure rates, less need for additional surgery and procedures; and more experience = less complications (which can be potentially fatal).  Your doctor may have a hard time finding you an experienced adrenal surgeon. You may be referred to a general surgeon, a general surgeon specialized in endocrine surgery or minimally invasive surgery, such as a weight-loss surgeon, or even a urologist.  You want the surgeon that can provide you the most experience in considering all factors that come into play with surgery of the adrenal glands. 

Your surgeon must be able to interpret your blood work showing the adrenal gland hormones being produced, the effects these elevations in hormones have on your body, and how your body and hormones will be affected after the adrenal gland has been removed.  Your surgeon must be able to interpret your X-ray studies, whether you have had a CT scan, MRI, PET scan, or other specialized imaging tests looking at your adrenal gland.  Your surgeon must be able to provide the best operation for you and he/she should be able to explain it to you in such a way that it makes sense.  Thus, you can see how proven experience in treating people like yourself goes a long way in finding the right surgeon for you.

To learn more about choosing the best adrenal gland surgeon go here: https://www.adrenal.com/adrenal-surgery/best-adrenal-surgeon

Worry #3: How will my surgeon perform my adrenal gland removal?

A personalized approach tailored just for you is what you want your surgeon to provide, since clearly, one size does not fit all.  To best answer how your surgeon will perform your adrenal gland removal, you need to know your options before meeting the surgeon.  Adrenal surgery falls under three main headings: endoscopic through the back (Mini Back Scope Adrenalectomy); laparoscopic (through the belly using scopes); or open (through the belly with a large incision).

While these are broad headings for adrenal surgery, this is where you should focus your discussions with your surgeon.  The minimally invasive, or laparoscopic, approach to adrenal gland removal falls under two main categories (through the back or belly) based on the surgeon’s expertise, tumor characteristics, and your body type (morbidly obese, obese, muscular, thin).  Most will be provided a choice, and most will recognize the endoscopic approach through the back (Mini Back Scope Adrenalectomy) as the best way for to surgically remove an adrenal gland for almost all people and almost all adrenal tumors.

Advantages of going through the back for to remove the adrenal gland as opposed to the belly have a lot to do with geography.  The adrenal gland sits in the back, under the 12^th rib, on top of the kidney, and thus, removing the adrenal gland through a Mini-Back Scope technique makes a lot of sense for most people since there is less distance to travel in reaching the adrenal gland.

To read about the Mini Back Scope Adrenalectomy (MBSA), go here: https://www.adrenal.com/adrenal-surgery/mini-scope-adrenal-surgery

When going through the belly, the liver and intestines need to be moved for a right-sided tumor, whereas the intestines, spleen, and pancreas need to be moved just to visualize the left adrenal gland.  With the Mini-Back Scope approach to adrenal gland removal, the space just above the kidney where the adrenal gland lives is immediately encountered.  Less manipulation of internal organs to isolate the adrenal gland makes for shorter operative times, shorter anesthesia time, less pain after surgery, and quicker recovery times (earlier walking, eating, and return to work and daily activities).

The open approach using a big incision in the belly for adrenal gland removal is typically reserved for known or suspected adrenal cancer or the large tumor (greater than 10 cm) that is growing into or involving surrounding structures.  With the open approach, there are potential pitfalls that can be encountered which are not as common with a more minimally invasive technique, including: constipation, nausea, increased pain, longer hospital stays, increased time before return to work and daily activities, and incisional hernia.

Worry #4: Is there a team in-place to care for me before, during, and after adrenal gland removal?

To alleviate this worry, you want to find the best team, or best center, for your adrenal surgery.  While considering your surgeon’s experience and the personalized approach to adrenal gland removal being offered, just as important in the decision-making process is the team with which you will find yourself leading up to the surgery, during the surgery, and during your recovery.  Your team must provide you the comfort that they will support and encourage you through your successful surgery, starting before you even make it to the hospital.  A surgeon’s team is vital to surgery success and the overall best surgery experience, and thus, the team that you decide to trust for your operation must have the knowledge, expertise, and compassion to support you as you deem fit.  Being faced with adrenal gland surgery is not easy, but fortunately, there are surgeon-driven teams established for your success and the best possible outcomes.

Adrenal gland removal is a potentially scary proposition with several associated worries.  Fortunately, there are teams in-place to help you every step of the way.  Teams drive success and success drives the team in doing everything they can for a safe and smooth operation.  If you or a loved one needs adrenal gland surgery, educate yourself on what that means.  Let the worries fade away as the reassurance and comfort of a safe operation by an expert team takes their place.  

To learn more about our center specializing in adrenal gland removal, go here: https://www.adrenal.com/about