ADRENAL GLAND
ANATOMY
The adrenal glands sit on top of each kidney in the back of the abdomen. The adrenal gland itself is very small (about the size of a strawberry) but has a lot of functions. Adrenal glands make adrenaline like hormones (epinephrine and norepinephrine) as well as steroid hormones that help regulate blood pressure as well as kidney function. The adrenal glands themselves are very fragile and small.
Often masses in the adrenal gland are noted incidentally with a study such as an ultrasound or a CT scan of the abdomen done for another reason. Most masses if they are small and do not produce hormones (incidentaloma) can usually be observed closely with follow up scans. If the masses do not enlarge they are usually not a major concern. However, if a mass is large (> 2 inches in size) or is growing, the risk of it being a cancer rises. Also, if any mass is found to be producing hormones (through blood and urine tests) a patient’s health can be at risk. In both instances, surgical removal should be considered.
Sometimes tumors such as adenomas or adenocarcinomas can develop in an adrenal gland where cells that make a certain hormone can become overstimulated and grow to form a tumor mass. Some tumors create adrenaline type hormones (pheochromocytoma) or other hormones that can overproduce blood pressure raising hormones (Conn’s disease = overproduction of mineralcorticoids) or can overproduce stress steroid hormones (Cushing’s syndrome = glucocorticoids such as cortisol). Sometimes these masses can produce enough hormones that it can affect the body’s ability to function properly. When that condition arises often surgery is required to remove the mass in question to help return the body back to normal.
A certain tumor called a pheochromocytoma results in over production of adrenaline like hormones and can cause dangerous rises in blood pressure and cause harm. To safely remove the tumor, preoperative treatment involves having the patient take blood pressure lowering medicines over several weeks and increasing fluid intake. Once the blood pressure is more normalized and stable then it is safe to remove the tumor.
Surgical removal often can be done laparoscopically. This involves undergoing complete general anesthesia with the patient positioned to lie on the opposite side of where the tumor is (for example a patient lies on the right side if there is a left sided tumor) to allow the side in question to be elevated. A few tiny incisions (ex. A-D in the picture above) are made in the abdomen and the abdomen is filled up with air and a telescope like camera and long small laparoscopic instruments are used to help free the gland from its blood supply that it receives from the kidney and main artery and often from other areas as well which hopefully will free that gland out in its entirety. Some cancers can be freed out leaving the rest of the adrenal gland intact. However, because the adrenal gland tends to be extremely small and friable and prone to bleeding it is often safer to remove the entire gland (adrenalectomy) on that side leaving one other gland to be able to more than adequately produce the rest of the hormones needed for the body to function. People often stay hospitalized for a couple of days to make sure they have adequate pain control and their bowels are functioning and there are no problems with bleeding. Sometimes larger tumors require a larger open incision to more safely remove the mass.
This surgery can be performed by surgeons at Regional Surgical Specialists. If you have any questions or concerns please contact us at 828-252-3366.
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