Adrenalectomy

An adrenalectomy removes a hormone-producing organ, not simply a mass. The patient’s greatest perioperative risk depends on what the tumor has been secreting and how the remaining adrenal tissue has adapted. A unilateral adrenalectomy is commonly performed for a functioning adenoma, pheochromocytoma, or a mass concerning for malignancy. Minimally invasive surgery, either laparoscopic transperitoneal or posterior retroperitoneoscopic, is preferred when tumor and patient characteristics permit because it lowers perioperative morbidity. Open surgery is more likely when the mass is large, locally invasive, or suspicious for adrenocortical carcinoma. The three hormone patterns create very different postoperative threats: - Catecholamine-secreting pheochromocytoma: The circulation has adapted to excess epinephrine and norepinephrine. Manipulation of the tumor can cause extreme hypertension and dysrhythmias; after adrenal-vein ligation, catecholamine levels collapse and profound hypotension can follow. - Cortisol-secreting tumor or overt Cushing syndrome: Chronic cortisol excess suppresses the hypothalamic-pituitary-adrenal axis. The opposite adrenal gland may not produce enough cortisol to meet surgical stress after the diseased gland is removed. - Aldosterone-producing adenoma: Aldosterone excess drives sodium retention, hypertension, and potassium loss. After successful unilateral surgery, the previously...