Adrenalectomy - Adrenal Gland Surgery

Adrenalectomy is a surgical procedure involving the removal of one or both adrenal glands, which are paired endocrine structures located superior to each kidney. The adrenal glands are composed of two distinct regions: the outer cortex, responsible for producing corticosteroids (such as cortisol, aldosterone, and androgens), and the inner medulla, which secretes catecholamines (epinephrine and norepinephrine). These hormones regulate critical physiological functions, including metabolism, blood pressure, fluid balance, and the body’s response to stress.

Adrenalectomy may be unilateral or bilateral, depending on whether one or both glands are removed. The procedure can be performed using either an open or minimally invasive approach, depending on factors such as gland size and pathology. While unilateral adrenalectomy allows the remaining gland to compensate for hormone production, bilateral adrenalectomy results in adrenal insufficiency, necessitating lifelong hormone replacement therapy. The surgical intervention requires careful perioperative management to prevent hemodynamic instability due to potential hormone fluctuations, particularly in cases involving catecholamine-secreting tumours.

Why Cuba

In Cuba, adrenalectomy procedures are meticulously planned and executed by highly trained specialists, ensuring optimal patient outcomes while maintaining hormonal stability. The country’s medical expertise extends to adrenal gland surgeries, with specialists employing advanced techniques to safely remove adrenal tumours or diseased glands while minimizing surgical risks. Given the adrenal glands’ critical role in hormone production, Cuban surgical teams conduct comprehensive preoperative evaluations to assess endocrine function and develop individualized treatment plans.

Cuba offers both traditional and minimally invasive adrenalectomy approaches. Postoperative care is carefully managed to prevent hormonal imbalances, particularly in cases requiring lifelong steroid replacement therapy following bilateral adrenalectomy. With a strong emphasis on patient-centered care, Cuban medical facilities ensure that individuals undergoing adrenalectomy receive thorough monitoring and tailored endocrine management to support long-term health and well-being.

Importance of the Adrenal Glands

The adrenal glands are vital endocrine organs responsible for producing essential hormones, including:

• Cortisol: Regulates metabolism, immune response, and stress adaptation.
• Aldosterone: Controls sodium and potassium balance, impacting blood pressure.
• Epinephrine and Norepinephrine: Also known as adrenaline and noradrenaline, these hormones regulate the body’s “fight-or-flight” response.
• Androgens and Estrogens: Influence secondary sexual characteristics and reproductive functions.

Any dysfunction in these glands can disrupt hormonal balance, leading to serious medical conditions requiring surgical intervention.

Conditions That Require Adrenalectomy

Adrenalectomy is indicated for various conditions affecting adrenal gland function, including:

• Adrenal Tumours
  • Benign Tumours (Adenomas): Non-cancerous growths that may overproduce hormones.
  • Adrenocortical Carcinoma (ACC): A rare but aggressive cancer.
  • Pheochromocytoma: A tumour that produces excessive adrenaline, causing severe hypertension.

• Hormonal Disorders
  • Cushing’s Syndrome: Overproduction of cortisol, leading to weight gain, high blood pressure, and diabetes.
  • Conn’s Syndrome (Primary Aldosteronism): Excess aldosterone, causing high blood pressure and potassium imbalance.
  • Congenital Adrenal Hyperplasia (CAH): A genetic disorder affecting adrenal hormone production.

• Metastatic Disease
  • Cancers from other organs, such as the lungs or kidneys, may spread to the adrenal glands.

• Bilateral Adrenalectomy
  • In rare cases, both adrenal glands are removed due to genetic conditions like multiple endocrine neoplasia (MEN) syndromes.

Causes of Adrenal Disorders

Adrenal disorders develop due to various factors, including:

• Genetic mutations: Some adrenal tumours and hyperplasias have hereditary links.
• Autoimmune diseases: Conditions like autoimmune adrenalitis can impair adrenal function.
• Chronic stress: Long-term stress affects cortisol regulation, leading to adrenal gland dysfunction.
• Endocrine system disorders: Imbalances in hormone-producing glands can contribute to adrenal diseases.
• Cancer metastasis: Tumours from other organs can spread to the adrenal glands.

Symptoms of Adrenal Disorders

Symptoms depend on the underlying condition but may include:

• High blood pressure (common in pheochromocytomas and Conn’s syndrome)
• Unexplained weight gain (often seen in Cushing’s syndrome)
• Muscle weakness and fatigue
• Excessive sweating and palpitations
• Frequent headaches and anxiety
• Hyperpigmentation (darkening of the skin in adrenal insufficiency)
• Electrolyte imbalances (low potassium, high sodium)

Pre-Surgical Diagnosis and Evaluation

Before recommending an adrenalectomy (surgical removal of one or both adrenal glands), a thorough diagnostic evaluation is essential. This ensures that the surgery is necessary, determines the underlying condition causing adrenal dysfunction, and helps plan the most effective surgical approach.

• Hormonal Blood and Urine Tests: Cortisol, aldosterone, catecholamines, and other hormone levels are assessed.
• Imaging Studies: CT Scan or MRI – Helps identify tumour size, location, and malignancy potential. PET Scan are used when metastatic disease is suspected.
• Adrenal Vein Sampling (AVS): A specialized test to determine which adrenal gland is overproducing hormones.

Surgical Options for Adrenal Disorders

Adrenalectomy is a life-saving procedure for patients with adrenal gland disorders, particularly those caused by hormone-producing tumours or adrenal malignancies.

Laparoscopic (Minimally Invasive) Adrenalectomy

• Laparoscopic adrenalectomy is the preferred surgical approach for removing adrenal tumours that are small to moderately sized, benign, and non-invasive.

• The procedure involves making 3 to 4 small incisions in the abdomen or flank, through which a camera (laparoscope) and specialized surgical instruments are inserted, allowing for the careful dissection and removal of the gland with minimal damage to surrounding tissues.

• Laparoscopic adrenalectomy reduces post-operative pain, shortens hospital stays and speeds up recovery time, making it the gold standard for most benign adrenal tumours.

• Laparoscopic adrenalectomy is not suitable for large tumours (>6 cm), suspected malignant tumours, or cases with extensive surrounding tissue involvement. In such cases, open adrenalectomy is preferred to ensure complete removal and reduce the risk of tumour rupture.

This procedure can be performed using different techniques:

• Transabdominal Laparoscopic Adrenalectomy: The instruments are inserted through the abdomen, providing excellent visibility of the adrenal gland, especially for right-sided tumours.

• Retroperitoneoscopic Adrenalectomy (Posterior Approach): A minimally invasive technique that accesses the adrenal gland through the back, avoiding the abdominal cavity.

Open Adrenalectomy (Traditional Surgery)

• Open adrenalectomy is a more invasive procedure used for large tumours, suspected malignancies, or tumours that have invaded nearby structures such as the kidney, liver, or major blood vessels.

• The procedure involves making a large incision in the abdomen, flank, or back to provide direct access to the adrenal gland. This approach offers the best visibility and control for complex cases, making it the preferred option for adrenocortical carcinoma (ACC) and aggressive pheochromocytomas.

• Open adrenalectomy allows for complete tumour removal, however, it is associated with longer recovery times, increased post-operative pain, and a higher risk of complications such as bleeding, infection, and delayed wound healing. Despite these drawbacks, it remains the best option for high-risk patients, particularly those with suspected or confirmed cancer.

The three main types of incisions used in open adrenalectomy include:

• Anterior (Transabdominal) Approach: A large incision in the front of the abdomen, providing wide exposure to the adrenal gland and surrounding structures.

• Posterior (Retroperitoneal) Approach: An incision in the back, offering direct access to the adrenal gland without entering the abdominal cavity.

• Thoracoabdominal Approach: A combination of a chest and abdominal incision, used for very large or invasive tumours.