Tumors of the adrenal glands can be either malignant (cancer) or benign (non-cancer). These tumors can cause different symptoms. Some patients are diagnosed with primary hyperaldosteronism, a condition where too much aldosterone is produced by the adrenal glads, which can cause lower levels of potassium in the blood. In 80% of these patients it is caused by an adenoma (benign tumor) in the adrenal cortex that releases too much aldosterone. Symptoms may include high blood pressure, low blood potassium levels and muscle weakness. Cushing's syndrome is also caused by an adrenal cortex tumor. Symptoms may include moon face (round, puffy face), buffalo hump (an increase in fat pads just below the back of the neck), truncal obesity (increase in weight around the abdomen), wasting of your muscles, easy bruising, facial hair, purplish "stretch marks" on your abdomen, high blood pressure and changes in emotions from feelings of high to low. Another type of adrenal tumor is called a pheochromocytoma. Pheochromocytomas are usually located in the adrenal medulla. About 85- 90% occur at random, but some may occur in families. Symptoms can include headache, sweating, palpitations (rapid heartbeats), and high blood pressure.  There will also be high levels of catecholamine (epinephrine and norepinephrine) in the urine and blood.

Most adrenal tumors can be removed by a surgical procedure called laparoscopic adrenalectomy. In a small number of patients it may be necessary to convert a laparoscopic adrenalectomy to an open adrenalectomy. For some patients, an open adrenalectomy may be preferable initially. Your surgeon will explain your specific surgery and why it is recommended in your case. As with any surgical procedure, there are risks involved. There is a risk of bleeding and extreme changes in blood pressure. The risk of infection is so low that antibiotics are not routinely used. There is also a very low risk of pneumonia, injury to bowel, spleen, pancreas or liver. There is also a small risk associated with anesthesia. However, the relative risk of complications is very low and is usually outweighed by the potential benefits of having the surgery. Your surgeon will go over this information with you and answer any questions you might have. An adrenalectomy is surgery to remove one or both adrenal glands.

One adrenal gland sits above each of your kidneys. Your two adrenal glands produce various hormones that help regulate your metabolism, immune system, blood pressure, blood sugar and other essential functions. Most adrenal tumors are noncancerous (benign). You may need surgery (adrenalectomy) to remove an adrenal gland if the tumor is producing excess hormones or is large in size (more than 2 inches or 4 to 5 centimeters). If you have a cancerous tumor, 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 or lung. minimally invasive (laparoscopic) surgery for tumors of the adrenal gland because the gland is relatively small. Doctors perform laparoscopic surgery through several small cuts (incisions). This type of surgery uses a tiny camera and surgical instruments. Doctors have a magnified, 3D view of the surgical site. Laparoscopic surgery has many benefits. For example, this surgery has smaller scars, less pain and a shorter recovery period than traditional open surgery. An alternative to laparoscopic surgery is a posterior retroperitoneoscopic adrenalectomy (PRA). In this procedure, surgeons make small cuts (incisions) in your back. Sometimes surgeons perform robot-assisted adrenalectomies. They perform the surgery through small cuts (incisions) using robotic arms with a camera and instruments attached. The camera gives doctors a high-definition, magnified, 3D view of the surgical site.

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Richard Potvin

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General Surgery: Open Access