Adrenal Surgery FAQ

Incidentally discovered adrenal masses

Q: What types of adrenal surgery are there?

transabdominaladrenalectomy Laparoscopic transabdominal adrenalectomy
This is the most common minimally invasive approach used by surgeons to remove the adrenal gland. Three to four small incisions will be made under your rib cage (see diagram) which the surgeon will use to access the adrenal gland by going through the abdominal cavity.
retroperitonealadrenalectomy Laparoscopic retroperitoneal adrenalectomy
This is another minimally-invasive approach to remove your adrenal gland, only performed at a few specialized centers, such as Providence Saint John’s Health Center. Three small incisions are made in your back below your 12th rib (see diagram) which the surgeon will your to access the adrenal from behind without entering the abdominal cavity.
open_adrenalectomy Open adrenalectomy
A large abdominal incision is used when there is a diagnosis or a strong suspicion of adrenal cancer before your surgery. Occasionally, other large tumors may also require an open operation.

Q: Is the whole adrenal gland always removed?

  • Generally, the entire adrenal gland is removed during surgery. This leaves you with one whole, healthy gland on the other side, which will provide all the hormonal control that you need.
  • In special circumstances, such as patients with bilateral tumors or hereditary syndromes, a partial or cortical-sparing adrenalectomy (where we leave a small part of normal adrenal tissue behind) may be performed.

Q: What type of anesthesia will I have?

  • General anesthesia

Q: How long does surgery take?

  • Laparoscopic surgery usually takes anywhere from one to three hours once you are asleep, depending on the type of surgery you are having and the difficulty of the case.

Q: How long will I be hospitalized?

  • Most patients who undergo a laparoscopic adrenalectomy will spend one to two nights in the hospital.
  • Patients who undergo open adrenal surgery will generally spend three to six days in the hospital.
  • For patients with functional tumors (ones that make steroids, catecholamines, aldosterone), the length of stay may depend somewhat on getting on the right medication for discharge.

Q: How long is recovery? When can I go back to work?

  • Recovery is usually a few days, mainly due to a generalized fatigue after anesthesia.
  • Most people that undergo a laparoscopic adrenalectomy take off up to a week from work. Open surgery requires a longer recovery.

Q: What are the risks of surgery?

  • The risks of surgery are rare, but exist, and are similar to any abdominal surgery. These include bleeding, infection, injury to nearby blood vessels and structures, or possible need for conversion to an open surgery.

Q: When will I know the findings of the surgery?

  • The results of your final pathology can take up to seven business days. The surgeon will call you with the results if they are back in a few days or at your follow-up appointment.

Q: Will I have a big scar?

  • The incisions from laparoscopic surgery are very small and leave very minimal evidence after six to 12 months after surgery.

Q: Will I have stitches?

  • For patients that have a laparoscopic surgery there will not be any stitches to remove.
  • Patients that need open surgery will most likely have staples that will be removed at 10 to 20 days after your surgery.

Q: Will I have to take medication after my adrenal gland is removed?

  • If you have one adrenal gland removed, there is no need to take supplements. Your other remaining gland will produce all the hormones you need. However, if the adrenal mass you had removed was producing cortisol before surgery (we know this from checking blood tests), then you will likely need to take steroids for a period of time after your surgery. Your physicians will discuss this with you further.

Q: Will I need follow-up appointments once my adrenal gland has been removed?

  • You will have a follow-up appointment with your surgeon generally 10 to 14 days after surgery.
  • If you had surgery because your tumor was functional (meaning that it produced hormones), it is very important to have regular follow-up with endocrinologist and possibly your surgeon to check your blood tests.

Incidentally discovered adrenal masses

Q: I had a CT scan for an unrelated reason and it showed I have a mass on one of my adrenal glands. What should I do?

  • Most incidentally-discovered small adrenal masses are benign.
  • However, appropriate workup (see below) is very important and should be evaluated by an endocrinologist and/or and endocrine surgeon.

Q: What is the workup?

  • Workup includes a series of blood tests, sometimes urine tests, and imaging. There is no role for needle biopsy unless a tumor is strongly felt to be a metastatic lesion from another cancer.

Q: Do I need surgery?

  • Surgery is generally reserved for tumors that are making hormones (determined by your lab tests), growing in size over time, larger (greater than 3 to 4 cm), or have very suspicious radiologic characteristics.

Q: Where can I find additional resources and information?