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ADRENALECTOMY

Why an Adrenalectomy is performed ?

There are two adrenal glands; one is located above each kidney. Each adrenal gland consists of two separate parts, an outer cortex and an inner medulla. The adrenals produce two groups of hormones which are needed to maintain normal body functions. The medulla secretes adrenaline and is responsible for part of the response to stress.

The cortex secretes cortisone-like steroids which maintain the water and salt content of the body and also help to deal with stress. Excessive production of adrenaline (phaeochromocytoma) causes an exaggerated stress phenomenon of high blood pressure, shaking attacks and sweating. Excessive secretion of steroid hormones produces high blood pressure, weight gain and muscular weakness. This condition is called Cushing's disease. Cushing's disease is often treated by direct approach to the pituitary which controls the adrenals and is situated at the base of the brain behind the root of the nose.

On occasion this fails, and so the removal of both adrenal glands becomes necessary. Cushing's syndrome is the name applied when one adrenal is overactive, usually due to the development of a benign tumour. Rarely a benign or malignant tumour of one adrenal gland produces male hormones in increased quantity. This causes male characteristics, including hair growth in an affected woman. Even more rarely, a tumour of the adrenal is non-functioning, producing no abnormal or excessive hormones.

Preparations needed for an Adrenalectomy

Patients undergoing adrenalectomy for whatever cause normally need extensive drug treatment prior to surgery. You may need to spend a week or more in hospital on drug treatment before the surgery is contemplated and undergo a variety of blood, urine and other tests. Once these tests are within or near the normal range, you will be considered safe for adrenalectomy. Surgery without such medical correction of the hormone disorder may render an anaesthetic dangerous or delay wound healing.

What Happens during an Adrenalectomy

To remove an adrenal gland, it is essential that you are operated on under general anaesthesia. Prior to surgery, to prevent leg clots, you may be given special stockings and regular injections of heparin to thin the blood. Adrenal glands may be removed either by a cut in the front of the stomach or by a cut in the back. The exact sort of cut depends on the size and position of the tumour within the adrenal gland. Where possible, the surgeon removes the tumour from the back, since this makes the post-operative recovery of the patient a lot easier. Sometimes, however, it is essential that the tumour or tumours are removed from the front, and this will mean that you will have a small tube in the nose for several days, in order to keep the stomach empty. During the operation drugs will be given to maintain the blood pressure. It is quite common for you to need a blood transfusion during the operation.

Possible Complications of an Adrenalectomy

Major complications in adrenal surgery are rare if the operation has been performed from the back. You are soon very mobile and complications such as clotting in the veins, chest infection and pneumonia are unusual. They are commoner if the operation has been performed through the stomach because of the site of the tumour.

After an Adrenalectomy

After the adrenal operation, you will almost certainly be sent to the intensive care unit (ITU) and not back to the normal ward. This is because the surgery is major and ITU will monitor the blood pressure, pulse and temperature, and the urine from the kidneys. Most patients need to stay in ITU overnight or for 24 hours. This is just a routine safety measure and should not alarm you. Some patients will have tube drains from their wounds, to avoid accumulation of blood and other fluids under the wound, but this is not always the case.

If surgery has been performed through the back, you should be able to eat normally within 48 72 hours. If the surgery has been performed through an abdominal approach, eating is usually delayed for 4 to 5 days. After 4 to 5 days the drains and drips will be removed and you will be fully mobile. At 7 to 10 days the stitches will be removed and you can usually be discharged home by the tenth day. If only one adrenal has been removed, it may not be necessary for you to take any additional long-term drugs. However, because the hormones produced by the adrenal glands are essential to life, it is necessary to take steroid replacement tablets if both adrenals are removed.

These steroid hormones, called hydrocortisone and fludrocortisone, need to be carefully controlled. It is important to carry some identification in case of a serious accident to show that these tablets are being taken. If you develop a completely incidental infection, it is usually necessary to increase the dose of tablets and, if vomiting, hydrocortisone must be given by injection immediately.

If an Adrenalectomy is not performed

In patients needing adrenalectomy, there is often little other choice than surgery to relieve symptoms. If you have Cushing's disease and surgery is not performed, your health will deteriorate. If the condition is a phaeochromocytoma (tumour of the part of the adrenal that produces adrenaline), drug treatment is available as a less desirable alternative to surgery. However, it should be stressed that adrenal surgery is safe.

Effects on Family of an Adrenalectomy

People living with you may need to remind you about increasing your tablet doses with stress of any type. It is worth informing them about the emergency treatment required for vomiting.

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