What are the adrenal glands and what is adrenalectomy?
The adrenal glands are two small glands, one sitting on top of each kidney. They make hormones that control blood pressure, salt and potassium balance, blood sugar and the body’s response to stress: aldosterone, cortisol, and adrenaline and noradrenaline.
An adrenal tumour is a lump in one of these glands. Most are benign (not cancer), but some make too much of a hormone and cause illness, and a few are cancerous. Adrenalectomy means removing the affected gland, usually through keyhole surgery. You can live a normal life with one adrenal gland, because the other gland takes over.
Types of adrenal tumour: incidentaloma, Conn’s, Cushing’s and phaeochromocytoma
Adrenal incidentaloma
A lump found by chance on a CT or ultrasound done for another reason. Every incidentaloma needs hormone tests and a careful look at the scan, because the next step depends on whether it makes hormones and how it looks.
Conn’s syndrome (primary aldosteronism)
Too much aldosterone causes high blood pressure that is hard to control, often with low potassium, which can cause tiredness, muscle weakness and cramps. When one adrenal gland is the source, removing it can help.
Cushing’s syndrome
Too much cortisol causes weight gain around the face and trunk, thin skin that bruises easily, purple stretch marks, muscle weakness, diabetes, high blood pressure and weak bones. Some adrenal tumours make a smaller excess of cortisol without obvious signs, which still matters before surgery.
Phaeochromocytoma
A tumour that makes adrenaline-like hormones. It causes episodes of headache, sweating, a pounding heart and very high blood pressure. It needs careful preparation before surgery, explained below.
Adrenal cancer and other lumps
Adrenal cancer is rare. Large lumps, or those with worrying features on CT, are usually removed. Simple cysts and fatty lumps called myelolipomas usually only need removal if they are large or cause pain.
Who needs adrenalectomy, and who does not
Surgery is usually advised for:
- A tumour that makes too much aldosterone, cortisol or adrenaline from one gland
- A lump that looks suspicious on CT or MRI, or a large lump (often taken as more than about 4 cm) unless the scan clearly shows a harmless type
- A lump that grows on follow-up scans
Surgery is usually not needed for a small lump that makes no extra hormone and looks benign; it may be watched with a repeat scan and tests. When both adrenal glands are overactive in Conn’s syndrome, medicines that block aldosterone are used instead. When Cushing’s syndrome comes from the pituitary gland in the brain, treatment is directed there, with the right specialist. Adrenal cancer that has spread into nearby organs usually needs open surgery and a cancer team; see urology cancer surgery.
Hormone tests and preparation before adrenal surgery
Adrenal surgery is planned together with an endocrinologist (hormone specialist). Tests usually include:
- Metanephrines in blood or urine, to look for phaeochromocytoma
- Aldosterone and renin blood levels, if you have high blood pressure or low potassium
- Dexamethasone suppression test, an overnight tablet followed by a morning blood cortisol, to look for extra cortisol
- CT or MRI of the adrenal glands, to see the size and nature of the lump
- Adrenal vein sampling in Conn’s syndrome when needed, to confirm which side makes the hormone
Preparing for phaeochromocytoma surgery
Handling this tumour during surgery can release a surge of hormone and push blood pressure dangerously high. To prevent this, you take alpha-blocker tablets for about one to two weeks before surgery, with plenty of salt and fluids, as the endocrinologist and anaesthetist advise. A beta-blocker may be added afterwards if the pulse is fast, never before the alpha-blocker. Genetic counselling is often advised, as some of these tumours run in families.
Other preparation
In Conn’s syndrome, potassium and blood pressure are brought under control first. In Cushing’s syndrome, blood sugar and blood pressure are controlled and plans are made for steroid cover after surgery. Routine blood tests, ECG and an anaesthesia check are done for everyone.
How laparoscopic adrenalectomy is done
- You are given general anaesthesia. For phaeochromocytoma, the anaesthetist monitors blood pressure continuously through a line in an artery.
- You lie on your side. Three or four small ports are placed below the ribs, and the abdomen is filled with gas.
- On the right, the liver is gently lifted; on the left, the spleen and bowel are moved aside to reach the gland.
- The main adrenal vein is found and closed with clips. In phaeochromocytoma this is done early, to limit hormone release.
- The gland with the tumour is freed, placed in a bag and removed through a slightly enlarged cut. A drain is sometimes left.
The operation usually takes 1.5-3 hours. The gland can also be reached from the back (retroperitoneoscopic adrenalectomy), or by robotic surgery where that is preferred (see robotic vs laparoscopic surgery); the route is chosen to suit the tumour and your body. Equipment includes the laparoscopic camera, ports, sealing devices, clip appliers and a retrieval bag. Very large tumours or suspected cancer may need open surgery. The operation is done at ManglamPlus Medicity, Mansarovar, with the anaesthesia team; for a general explanation of keyhole surgery, see laparoscopic urology surgery.
Steroid cover after adrenalectomy: when it is needed
If the tumour was making extra cortisol, the other adrenal gland has been switched off for a long time and cannot make enough cortisol straight away. Without replacement this can cause adrenal insufficiency: severe tiredness, dizziness, vomiting and low blood pressure.
- Steroid tablets (hydrocortisone or a similar medicine) are started at the time of surgery and reduced slowly over weeks to months, guided by blood tests.
- During illness, vomiting or another operation, the dose usually needs to be increased; your endocrinologist gives you written sick-day rules.
- If both adrenal glands are removed, steroid replacement is lifelong.
After surgery for Conn’s syndrome, potassium tablets and aldosterone-blocking medicines are usually stopped, and blood pressure medicines are reduced step by step. After phaeochromocytoma surgery, blood pressure and blood sugar are watched closely for the first day, as both can fall.
Hospital stay and recovery after adrenalectomy
| When | What usually happens |
|---|---|
| Day of surgery | Close monitoring of blood pressure, pulse and sugar; sips of fluid within hours |
| Days 1-3 | Walking, normal diet, catheter and drain removed; potassium or cortisol checked; discharge for most people |
| Weeks 1-2 | Short walks, light activity, review of the tissue report and medicines |
| Weeks 2-6 | Back to desk work for most people in two to three weeks; heavy lifting after about six weeks |
Call the clinic if you have fever, worsening abdominal pain, repeated vomiting, a wound that is red or leaking, or very high or very low blood pressure readings. If you are on steroid cover, seek urgent help for severe weakness, dizziness, vomiting or confusion.
Risks of adrenal surgery and how they are reduced
- Blood pressure swings in phaeochromocytoma: reduced by alpha-blocker preparation and close monitoring by the anaesthetist
- Bleeding: the right adrenal vein drains directly into the main vein of the body, so careful dissection is needed; transfusion is occasionally required
- Injury to nearby organs such as the liver, spleen, pancreas, bowel or kidney: uncommon
- Adrenal insufficiency: prevented with steroid cover when cortisol was high
- Conversion to open surgery for safety, wound infection, chest infection, port-site hernia and blood clots
Results and follow-up after adrenal tumour surgery
The removed gland is examined under a microscope, and the report usually comes within a week. Hormone tests are repeated after surgery to confirm the excess has gone.
- Conn’s syndrome: potassium usually returns to normal. Blood pressure usually improves, though some people still need tablets, especially if pressure was high for many years.
- Cushing’s syndrome: weight, skin, sugar and blood pressure improve slowly over months.
- Phaeochromocytoma: metanephrine tests are usually repeated every year for many years, often for life, because a new tumour can occasionally appear.
Laparoscopic adrenalectomy is closely related to laparoscopic nephrectomy, as both are done in the same area through similar ports.
Cost of laparoscopic adrenalectomy in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- Hormone tests, CT or MRI, and adrenal vein sampling if it is needed for Conn’s syndrome
- Days of preparation with alpha-blockers before phaeochromocytoma surgery, and closer monitoring during and after it
- Size and type of the tumour, which affect operating time and whether open surgery is needed
- Steroid cover and follow-up hormone tests after surgery
- The room category you choose at ManglamPlus Medicity and the number of nights
- Your insurance policy’s terms, such as room-rent limits and waiting periods
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Laparoscopic adrenalectomy with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
An adrenal lump was found on my CT by chance. Does it need surgery?
Not always. It needs hormone tests and a review of the scan. Small lumps that make no extra hormone and look benign are usually watched. Surgery is usually advised if it makes hormones, looks suspicious or grows, and is often advised for large lumps. Contact the clinic and bring the CT report and images.
Why do I need tablets for one to two weeks before phaeochromocytoma surgery?
Alpha-blockers relax the blood vessels and protect you from a dangerous rise in blood pressure when the tumour is handled during surgery. Salt and fluids help refill the circulation, so pressure does not drop too much after the tumour is removed.
Will I need steroid tablets for life?
Usually not after removing one gland. If the tumour made extra cortisol, steroid tablets are needed for weeks to months until the other gland recovers. Lifelong steroids are needed only if both glands are removed.
Will my blood pressure become normal after surgery for Conn’s syndrome?
Blood pressure usually improves and potassium usually returns to normal. Many people need fewer tablets, but some still need some medicine, especially if high blood pressure was present for many years.
Is an adrenal tumour cancer?
Most adrenal tumours are benign. Adrenal cancer is rare and is more likely in large lumps or those with certain features on CT. The final answer comes from the tissue report after removal.
Can I live normally with one adrenal gland?
Yes. The remaining gland makes enough hormones for normal life. Follow-up blood tests make sure it is working well.
Is adrenalectomy covered under RGHS, Ayushman Bharat or insurance?
Cover depends on the hospital’s empanelment and on your policy or scheme. Please confirm with the ManglamPlus Medicity billing desk before admission. See payment, insurance and schemes.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.