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Adrenalectomy - Procedure, Indications, and Contraindications

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Adrenalectomy is the surgical removal of the adrenal glands that are cancerous or diseased. Read the article below to learn about adrenalectomy.

Written by

Dr. Anahita Ali

Medically reviewed by

Dr. Shaikh Sadaf

Published At December 13, 2022
Reviewed AtDecember 13, 2022


The adrenal glands are triangular-shaped pairs of small glands located above or at the top of the kidneys. Though the size of these glands is relatively small, they play an essential role. These glands are responsible for producing male and female hormones, hormones that regulate blood sugar levels, blood pressure, steroids, dopamine, etc.

Any abnormality in the adrenal glands may affect the production of these essential hormones and affect the body's overall functioning. Sometimes, when medications cannot treat the disease of adrenal glands, then complete or partial removal of these glands is recommended. The surgical removal of the adrenal gland is called adrenalectomy. The surgery can be done through open or laparoscopic techniques. Laparoscopic adrenalectomy is nowadays the most commonly performed procedure.

What Is the Anatomy of Adrenal Glands?

Every gland has an outer layer called the adrenal cortex, and the center or inner layer is called the adrenal medulla. Both parts produce different hormones. The adrenal medulla contains ectodermal cells and produces three hormones - epinephrine or adrenaline, dopamine and norepinephrine. The adrenal cortex has three zones they are:

  1. Zona glomerulosa produces aldosterone.

  2. Zona fasciculata produces corticosteroid

  3. Zona reticularis produces aldosterone and androgen.

What Are the Functions of the Adrenal Glands?

The main functions of adrenal glands are:

  • Production of male and female hormones.

  • Production of hormones that help in regulating blood pressure and sugar levels.

  • Production of other hormones such as epinephrine or adrenaline, dopamine, and norepinephrine.

What Are the Indications of Adrenalectomy?

The removal of adrenal glands is indicated in the following conditions:

  • Primary Aldosteronism- It is a rare condition caused by excessive production of aldosterone.

  • Pheochromocytoma- It is a tumor of the adrenal glands.

  • Adrenal Cushing Syndrome- It is a rare condition with increased production of cortisol.

  • Ectopic Cushing syndrome- It is a tumor in which there is excessive production of adrenocorticotropic hormone.

  • Size: The mass or tumor in the adrenal gland is more than four centimeters.

  • Malignancy: Malignancy or cancer such as adrenocortical carcinoma. It is a type of cancer in which cancer cells are present in the adrenal cortex.

What Are the Contraindications of Adrenalectomy?

The adrenal glands should not be removed if there are:

  • A severe form of coagulopathy. It is a bleeding disorder in which the body fails to form a blood clot resulting in excessive bleeding.

  • Inadequate performance of the heart, lungs and muscles of the patient. It is done through a test called cardiopulmonary performance. The test measures how well these organs function while doing physical activity.

How Is Adrenalectomy Performed?

Adrenalectomy can be done through open or laparoscopic adrenalectomy. Laparoscopic adrenalectomy is considered the standard gold technique and is widely performed by doctors nowadays. The doctor can access the adrenal glands from two locations to remove them: through the abdomen (transabdominal) or from the back of the abdomen (peritoneal). Based on these approaches, mentioned below are the various techniques:

  1. Laparoscopic Adrenalectomy:

  • A minimally invasive procedure is done through a camera fitted in a long thin tube that sends an image on a monitor or screen called a laparoscope. A magnified or zoomed image is seen on the screen and guides the doctor.

  • In this process, the patient is given general anesthesia.

  • Multiple small incisions of three to four centimeters are made on the affected area or surgery site.

  • A laparoscope is then inserted through these incisions.

  • The internal structures are seen on the screen through which the doctor cuts the glands and removes them without damaging the surrounding tissues and structures.

  • The incisions are then closed with sutures or stitches.

The laparoscopic adrenalectomy can be done through a transabdominal or peritoneal approach as mentioned below:

1.1 Laparoscopic Transabdominal Adrenalectomy:

  • The patient is positioned in a supine position (the head and stomach face the roof).

  • General anesthesia is given to the patient.

  • Various laparoscopic ports are inserted from the lateral side of the abdomen.

  • Generally, three ports are used to perform the surgery. These ports must be placed with a gap of 5cm.

1.1.1. Right Adrenalectomy:

  • It is done to remove the adrenal gland on the right side.

  • The liver is retracted, and a cut is made on the posterior peritoneal space.

  • The adrenal vein is present just behind the liver, which is dissected.

  • If an additional adrenal vein is present two to three centimeters above the central vein, it should be dissected.

  • The adrenal gland and the fat tissues are lifted and dissected or cut.

  • It is then placed in a bag and taken out from the patient’s body.

1.1.2. Left Adrenalectomy:

  • On the left side of the abdomen, the spleen is present, which should be mobilized to remove the left adrenal gland.

  • A cut is made on the backside of the abdomen, exposing the spleen.

  • The sphenoparietal ligament is dissected or cut, allowing complete mobilization of the spleen.

  • The left adrenal gland is exposed by retracting the spleen, the tail of the pancreas, and the top part of the kidney.

  • Various important veins that pass through are divided and clipped, such as a renal vein, diaphragmatic vein, etc.

  • The left adrenal gland is dissected and placed into a bag.

  • It is then taken out of the patient’s body.

1.2. Posterior Retroperitoneal Laparoscopic Adrenalectomy:

  • The patient is positioned in a supine position.

  • An incision is made parallel to the last rib of the patient, and the retroperitoneal area is accessed.

  • A laparoscope is inserted, and then a laparoscope ultrasound is done to identify the exact location of the gland.

  • The gland is dissected and removed.

  1. Robotic Adrenalectomy:

  • This technique provides a three-dimensional zoomed view of the internal structures.

  • The surgery is done in the same way mentioned above but is done through a robot the doctor guides.

  1. Partial Adrenalectomy:

  • It is done in small tumor masses or small malignancies related to the excessive production of hormones in the adrenal glands.

  • This technique reduces the risk of future malignancy.

  1. Open Adrenalectomy:

  • It is done in patients with cancerous adrenal glands, such as a tumor size of more than six centimeters.

  • The surgery is performed in the same way mentioned above but is done without a laparoscope.

  • Large incisions are made to access the adrenal glands transabdominal or peritoneally.

What Are the Complications of Adrenalectomy?

  • Insufficiency of hormones in the body.

  • Depression.

  • Loss of libido (decreased interest in sexual activities).

  • Low energy levels.

  • Excessive production of cortisol.

  • Nelson’s syndrome (abnormal production of hormones).

  • Injury to the liver.


Adrenalectomy is commonly done nowadays through a laparoscopic technique. The complete removal of a single or both the adrenal glands is indicated when there is excessive production of the hormones or tumor. Laparoscopic adrenalectomy is considered the standard gold technique widely performed by doctors. An adrenal surgeon is the best to perform the adrenalectomy. Although there are various complications associated with this surgery, the rate of occurrence of these complications is low.

Frequently Asked Questions


Is Adrenalectomy a Major Procedure?

A laparoscopic adrenalectomy is a noninvasive procedure that allows access to the adrenal gland through tiny incisions and tools. Three to four tiny (0.5 to 1 cm) incisions are made in the abdomen to perform the surgery.


How Does Adrenalectomy Affect Your Health?

Lung-related complications are frequent in open adrenalectomies. In about 6 % of open adrenalectomies, pneumonia and atelectasis (Incomplete inflation or partial collapse of the lung) occur. Similar to other surgeries, there is a chance of wound infection, bleeding, and blood clot development in the leg veins.


What Is the Role of Both the Adrenal Glands in Survival?

The patient must take steroid hormones twice a day (Hydrocortisone and Fludrocortisone) if both adrenal glands are removed. In these situations, many people feel better after adrenalectomy even though living without adrenal glands necessitates lifelong medications.


When Should an Adrenalectomy Be Performed?

The presence of functional adrenal tumors, malignant tumors with a high risk of malignancy, or tumors with malignancy suspicion are indications for adrenalectomy. Functional tumors have surgical indications, irrespective of their size.


How Long One Can Live Without an Adrenal Gland?

After surgery, the other adrenal gland takes over the function of the remaining one if only one gland is removed. Hormone replacement therapy is not required in that circumstance.


What Are the Effects of Adrenal Gland Removal?

An Addisonian crisis can result from adrenal insufficiency because it prevents the body from producing more cortisol in response to stress. Low blood pressure, low blood sugar, and high blood potassium levels are the symptoms of an Addisonian crisis, a potentially fatal condition.


What Are the Chances of Adrenal Glands Growing Back After Removal?

Adrenal cancer treatment will require extensive follow-up care. Even after receiving treatment for early-stage disease, cancer can recur. Moreover, when significant amounts of the adrenal capsule or cortex are kept or transplanted in another part of the host, they grow back and may differentiate into other zones.


Which Hormone Is Substituted After Adrenalectomy?

Aldosterone, a hormone that helps the body to retain salt, is also produced by the adrenal gland. If both adrenal glands are removed, Florinef, typically 0.1 to 0.2 mg per day, should be used to replace aldosterone. Patients must also receive post-adrenalectomy glucocorticoid replacement therapy. The two synthetic glucocorticoids that are most frequently used in glucocorticoid replacement therapy are Hydrocortisone and Prednisone.


What Are the Effects of Adrenalectomy on Kidney Function?

Unilateral adrenalectomy can resolve glomerular hyperfiltration caused by an excess of aldosterone and reveal hidden renal damage. In conclusion, some patients may experience kidney function decline following adrenalectomy.


What Are the Complications of Adrenalectomy?

- BMI (body mass index). 
- Obesity is an independent risk factor that must be considered in all cases of minimally invasive surgery, including adrenalectomy. 
- Age.
- Tumor size.
- Tumor location.
- Pathology.
- Prior surgeries.
- Surgeon experience.


When Is Adrenalectomy Should Be Done?

Adrenalectomy is recommended for adrenal tumors that secrete too much hormone or for those that may be cancerous. Adrenalectomy can be performed in a variety of ways, including open and minimally invasive methods.


What Are the Steps to Be Followed After an Adrenalectomy?

Laparoscopic adrenalectomy recovery can take up to a month after surgery, and recovery from open adrenal surgery can take up to six weeks. Heavy lifting, motions that strain the abdomen, and strenuous activities should all be avoided during this time to prevent a hernia.


What Is the Death Rate From Adrenalectomy?

Although minimally invasive techniques and low mortality (1 %) are associated with adrenalectomy, recent reports show complication rates of 8 % to 19 % and a mean hospital length of stay of two to eight days.


What Is the Need for Hormone Replacement Following Adrenalectomy?

Adrenalectomy causes a significant drop in hormone levels that are vital for our bodies. Bilateral adrenalectomy patients need lifelong hormone replacement.  In unilateral surgery, the other gland assumes responsibility for both the adrenal glands' functions. This situation does not call for the use of hormone replacement therapy.
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Dr. Shaikh Sadaf
Dr. Shaikh Sadaf



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