What are the Adrenal glands?
A thumb sized, triangular shaped adrenal gland is located on the top of each of the two kidneys. Like other endocrine organs, they produce hormones and release them into the blood. Their inner parts secrete adrenaline, and outer parts secrete aldosterone and cortisol. These hormones maintain salt and water balance, control blood pressure, stress responses, and some sexual functions.

What causes adrenal problems?
Adrenal gland diseases are rare. Excess of hormones can be due to growths (usually not cancer). Deficiency of hormones can be due to spread of diseases like tuberculosis, cancer, etc. to the adrenals from other parts of the body.

How does an adrenal growth manifest itself?
Excess hormones produced by it can cause high blood pressure (hypertension), headache, palpitations, flushing, and sweating, anxiety, weakness, fatigue, cramps, tingling sensation, weak bones (osteoporosis), Diabetes, overweight-obesity, humping of the shoulder, blue streaks on the abdomen, acne and facial hair, reproductive dysfunction. Each tumor type over produces a particular hormone and hence has a unique set of features:

How do you detect an adrenal tumor?
Ultrasound, CT, MRI scans can detect adrenal tumors.
The tumor is identified by testing urine and blood for the hormones (and byproducts) produced by it. Sometimes Isotope and PET scans or selective venous sampling may be required to localize them.

How is the tumor removed?
Surgical removal of the adrenal gland is called adrenalectomy. This is best done by Laparoscopic Surgery, thus facilitating early recovery and return to normal activity. Large tumors are removed by Hand Assisted Laparoscopic Surgery or conventional open surgery. Sometimes laparoscopic adrenalectomy is not possible due to various factors and the surgeon may decide on open surgery either before or during the actual operation. There are many ways of approaching the adrenal in both laparoscopic & open surgery. The backside and side approaches are easier and faster but have certain constraints. The front approach is tedious but provides many more options. A specialist endoscopic (laparoscopic) & endocrine surgeon (a rare species!) would be conversant with all these methods and approaches and these technicalities are best left to the specialist surgeon to decide. Urologists, surgical oncologists, general surgeons, laparoscopic surgeons also operate on the adrenals, each by the method they are familiar with. Complications are rare if adequate preparations are done and precautions taken under the expert care of an experienced endocrine surgeon.

What can I do before adrenal surgery to be optimally prepared?
Several tests will be needed to assess the problem and the condition of your vital organs. Special medications will be started several days prior to surgery to control blood pressure, salt levels and other vital parameters. Blood thinning drugs or aspirin will have to be stopped several days prior to surgery. Quit smoking. You will need to provide written consent for surgery. Blood and/or blood products may be needed depending on your condition. Laxatives are usually given before surgery and you should not eat or drink anything after midnight the night before surgery, except medications that your doctor has told you to take with a sip of water the morning of surgery.

What can I expect after adrenal gland surgery?
After adrenal surgery vital parameters are carefully monitored, if required in an ICU. Medications for pain, blood pressure regulation and long term steroids may be required. After laparoscopic surgery most patients can resume normal activities within one week, including squatting, walking up stairs, lifting light objects, driving, and non strenuous work. After open surgery it may take 6 weeks to return to work. During this recovery refrain from vigorous exercise and lift no more than 5 kgs at a time.

Make a follow up visit as advised. If there is fever, bloating, nausea, vomiting, breathlessness or other problems call your surgeon.