What exactly is an adrenalectomy? Well, it represents term describing the surgical removal of one or both adrenal glands. Most people find this definition a bit insufficient because not many of them know what adrenal glands really are! Well, the adrenal glands are endocrine glands and there are two of them in our organism, one above each kidney. Although they seem small and not so important- nothing is more far from truth! They represent an important hormone factory which produces hormones such as epinephrine, norepinephrine, androgens, estrogens, Aldosteron, and Cortisol. Then, what is the purpose of the removal? It%26rsquo;s simple. It is usually done in cases of serious illnesses or tumors affecting these glands! The removal is usually performed by conventional surgery, although, like in other abdominal operations- surgeons may use laparoscopy, which offers far less scarring (four very small incisions) and shorter healing time!
Anatomical and histological structure of adrenal glands
Like it has been already mentioned, there are two adrenal glands and each of them is made of two separate parts, an outer- CORTEX and an inner part- MEDULLA. Not only that these structures are structurally different and made of different cells, but these two parts produce two different groups of hormones which are needed to maintain normal body functions. The medulla, inner part of the glands, secretes adrenaline, one very important hormone which is responsible for part of the response to stress. On the other hand, cortex is also made of three different parts:
%26middot; Fascicular zone
%26middot; Glomerular zone
%26middot; Reticular zone
The cortex secretes several different hormones called corticosteroids because they have the steroid structure. Some of them are Cortisol, Aldosteron and some sex hormones. Their main function is to maintain the water and salt content of the body and also help to deal with stress.
Conditions affecting the adrenal glands
Although there are several possible indications for the removal of the adrenal gland- important thing to know is that this operation- adrenalectomy is usually advised for patients with tumors of the adrenal glands. Like other tumors- all tumors of adrenal gland may be malignant or benign. There is only one problem- almost all of them typically excrete excessive amounts of one or more hormones. When we talk about some malignant tumor, this procedure should not only help in correcting hormone imbalances, but also in removing tumors cells before they invade other parts of the body. These parts of tumor are called metastases.
Other hormone effects
It is important to point out that excessive production of adrenaline, such as seen in one condition-tumor called phaeochromocytoma, causes an over-exaggerated stress phenomenon of:
%26middot; high blood pressure
%26middot; shaking attacks
%26middot; sweating
One other condition called the Cushing%26rsquo;s disease is characterized by excessive secretion of steroid hormones produces high blood pressure, weight gain and muscular weakness. Although, this condition can be treated with this operation, most of the experts believe that it is better to treat this condition 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.
When we talk about Cushing's syndrome, then we should know that it is the term used whenever one adrenal is overactive, usually due to the development of a benign tumor. Other also common consequence of this condition is male characteristics, even in women. There are also situations when the tumor is inactive and produce no hormones what so ever. Some studies done recently have shown that in some cases, hormones produced by the adrenal glands can actually aggravate another condition such as breast cancer.
Preparations for adrenalectomy
Everyone should know that this operation isn't something you can schedule for a next day! It is extremely important to point out that every patient which is candidate for an adrenalectomy normally needs extensive drug treatment prior to surgery. This sometimes last for several weeks, but in most cases, about a week. This is also accompanied with several blood, urine and other tests. Only after all these tests, a candidate is considered safe and prepared for the adrenalectomy.
Surgical techniques of adrenalectomy
1. Open adrenalectomy
It is important to point out that the surgeon has a freedom to operate from almost any possible direction because it can depend on the patient%26rsquo;s type of body or on the exact medical problem. The most common is the anterior approach, where the surgeon approaches the gland through the front abdominal wall. Usually the incision will be horizontal, just under the rib arc. Only in few cases - a vertical incision can be done only with purpose to provide a better approach, especially if both adrenal glands are involved. When we talk about a posterior approach, we should know that, in this case- surgeon makes an incision on the patient%26rsquo;s back, sometimes on one and sometimes on each side of the body. Although, there are many surgeons that favor this approach, because it is a lot easier to perform, the fact is that this approach does not provide quite as clear a view of the surrounding structures as the anterior approach.
Just to be noted, a flank approach is also possible but it is rarely done. Only indication is patient%26rsquo;s obesity!
The last, but the most rarely used approach is the thoracic approach where the incision is made into the chest cavity. Only indication for this kind of operation is the situation when we talk about a very large tumor.
2. Laparoscopic adrenalectomy
Almost everyone has heard about the laparoscopic surgeries because this technique has been very popular these last couple of years because of minimal scarring and shorter recovery time! Like it is well known, this technique does not require opening of the body cavity, but making four small incisions which are made into a patient's flank, just under the rib cage. What exactly is a laparoscope? Well, it is one instrument which enables the surgeon to visualize the inside of the abdominal cavity on a television monitor.
What Happens during an Adrenalectomy
Here are some hints about what is being done during the adrenalectomy. Well, the first rule is that it is always done in general anesthesia. Like with any operation of this importance, just before the operation, patient is given a lot of heparin, a drug that should prevent blood clotting. The main thing is to remove the tumor from the patient%26rsquo;s body, never mind the size of it. In most cases, several days after the operation, patient is caring a small tube in the nose for several days, in order to keep the stomach empty, which could be extremely important. Because adrenal gland is very hormone %26ndash;productive, it is possible that, during the operation, blood pressure drops significantly. That%26rsquo;s why, during the operation, drugs will be given to maintain the blood pressure.
Post operative facts
It is important to point out that, because we are talking about one very serious operation, after the operation every patient will spend some time in the intensive care unit (ITU). Why? Well the answer is simple. Adrenal glands control many functions in our body and that%26rsquo;s why, few days after the operation, doctors must monitor the patient%26rsquo;s blood pressure, pulse and temperature, and the urine from the kidneys.
If we would like to talk about the recovery time, then we should know that the shortest recover time is when the incision is made in the patient%26rsquo;s back! In this case, patient is usually able to eat normally within 48 to72 hours. If the surgery has been performed through an abdominal approach, recovery time is usually delayed for 4 to 5 days.
Life-time consequences
There are some facts that every patient should know about this operation. Because the hormones produced by the adrenal glands are essential to life, it is not necessary to point out that, it is unavoidable to take steroid replacement tablets top the rest of your life. Good thing is that this is only if both adrenals are removed. If only one adrenal has been removed, it may not be necessary for you to take any additional long-term drugs. These drugs are strong steroid medications and the most commonly used are hydrocortisone and fludrocortisone.
Possible Complications of Adrenalectomy
Good thing to know about this operation is that there are only few possible complications and that they are extremely rare! Clotting in the veins, chest infection and pneumonia are unusual, but they are possible. Several studies done in the past have shown that they are lot commoner if the operation has been performed through the stomach!
Hormonal imbalances
One very special consequence of the adrenalectomy is imbalance of some of the most important hormones in our body. This could be a big problem and cause several other symptoms such as delayed wound healing, blood pressure fluctuations, and other metabolic problems.
Other risks are typical of many operations. These include:
%26middot; Lung problems
%26middot; Surgical infections
%26middot; Pain
%26middot; Extensive scarring
%26middot; Bleeding
%26middot; Damage to adjacent organs (spleen, pancreas)
%26middot; Loss of bowel function
%26middot; Blood clots in the lungs
%26middot; Infection of the wound%26hellip;
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