What are Adrenal Tumors and how are they managed?
The adrenal glands are two triangular-shaped glands that sit on top of the kidneys. If you have certain adrenal gland disorders, your doctor may recommend that you have these glands surgically removed, also referred to as an adrenalectomy.
This article will share all about the adrenal glands and what you can expect if you need to have them surgically removed.
The Adrenal Glands
The adrenal glands are best known for their role in secreting stress hormones such as adrenaline and norepinephrine. These hormones are most needed when your body is in fight-or-flight mode. A fight-or-flight response occurs when your body detects danger, preparing you to spring into action for self-protection.
The adrenal glands may develop tumors that are cancerous or produce their own hormones. These are common reasons why your doctor may recommend an adrenalectomy.
Each adrenal gland is made up of two parts, the adrenal cortex and the adrenal medulla. The adrenal cortex and medulla each secrete their own types of hormones and serve different functions.
The adrenal cortex is the outer region of the adrenal glands.
One type of hormone produced by the adrenal cortex is corticosteroids which can be further broken down into two groups: glucocorticoids and mineralocorticoids. Glucocorticoids released by the adrenal cortex include aldosterone, cortisol, and androgens.
Cortisol regulates how the body converts certain food sources (such as fats, proteins and carbohydrates) to energy. It also helps to regulate blood pressure and heart function. Corticosterone works with hydrocortisone to regulate immune function and inflammatory responses.
Aldosterone, also known as the main mineralocorticoid which helps the body maintain salt and water balance to regulate blood pressure. The adrenal cortex also releases sex hormones in small amounts but these hormones are mainly produced by the ovaries and testes.
The adrenal medulla is the inner portion of the adrenal glands and is responsible for producing stress hormones. These hormones are released after the sympathetic nervous system has been stimulated, which happens as a result of physical or emotional stress. Stress hormones help the body react and adapt to stressful situations.
Hormones secreted by the adrenal medulla include epinephrine and norepinephrine. Epinephrine is also referred to as adrenaline. This stress hormone increases the heart rate and helps blood rush to the muscles and brain when the body experiences a stressful stimulation. It also increases blood sugar levels by converting glycogen stored in the liver to glucose.
Norepinephrine is also referred to as noradrenaline and it works with epinephrine to respond to stress. This hormone can cause a narrowing of the blood vessels which causes an increase in blood pressure.
Why is Adrenalectomy Performed?
There are a few main reasons why your doctor may recommend an adrenalectomy:
- You have an adrenal tumor that is producing excess hormones
- You have a tumor that is greater than 2 inches or 4 centimeters in size that increases the chance of it being cancerous
- You have a tumor on your adrenal glands coming from cancer of another area of your body
There are a couple of different techniques your doctor may utilize for performing an adrenalectomy including a laparoscopic or retroperitoneal approach, open adrenalectomy, or robotic surgery.
A laparoscopic adrenalectomy is minimally invasive and involves making a couple of small skin incisions in the abdomen. Your doctor will insert a long instrument into one incision with a camera on the end. They will use the camera to see where the adrenal glands are and remove them using other long instruments inserted into the other incisions. This procedure usually involves a shorter recovery when compared with other options.
Open adrenalectomies are an older method but they are still effective and perfectly safe. This type of invasive surgery requires a large abdominal incision to be made, through which your doctor will remove your adrenal glands. Because this abdominal surgery can require a longer recovery time, they are usually only used if a patient is not a good candidate for other less invasive approaches.
A robotic adrenalectomy will use a robotic machine to assist with surgery. This is a generally safe, advanced approach to adrenal surgery. Robotic surgeries are controversial amongst some medical professionals, given that they are costly and sometimes more time-consuming.
Posterior Retroperitoneoscopic Adrenalectomy
This approach to adrenalectomy is a new approach that offers benefits such as a shorter hospital stay, less scarring and less postoperative pain. A retroperitoneoscopic adrenalectomy removes the adrenal glands through small incisions made in the back.
The endocrinologists and endocrine surgeon at UCF Health have extensive knowledge of the different approaches to performing adrenalectomies. We use cutting-edge teaching tools to train our physicians and keep them updated on the latest surgical approaches.
Symptoms of Adrenal Gland Tumor
Symptoms are something that can only be described by the person who is feeling them, while signs are measured by a test. Some common symptoms of an adrenal gland tumor include:
- Abdominal pain
- Unexplained weight loss or gain
- Excessive hair growth
- Heart palpitations
Common signs of an adrenal gland tumor that your doctor can measure include:
- High blood pressure
- Low potassium levels
Diagnosis for Adrenal Gland Tumor
If your doctor suspects that you have an adrenal gland tumor, they’ll want to do some testing to establish a definite diagnosis. Below are some common diagnostic tests used for adrenal gland tumors.
MRI and CT Scan
Adrenal Vein Sampling
Sometimes patients show signs of having an adrenal tumor that is producing its own hormones but there are no signs of a tumor on imaging scans. In this case, your doctor may order an adrenal vein sampling. This diagnostic test is performed in a radiology center and involves taking blood samples from the veins of each adrenal gland. They then test the blood to see if extra hormones are coming from one or both of the glands.
Blood & Urine Test
Your doctor will likely order urine and blood tests to look for extra adrenal hormones in your body. You may be asked to complete a 24-hour urine test in which you have to collect all of your urine for a 24-hour period.
A biopsy involves taking a small tissue sample from a part of the body and sending it to a lab for testing. For a biopsy, a narrow long needle will be used to collect tissue from the adrenal glands. This procedure is performed by a radiologist who uses an imaging scan, such as a CT scan, to guide the needle into the correct place. A pathologist will then look at the tissue sample to determine if cancer is present.
Talk with your doctor prior to your surgery to make sure that you are aware of all potential risk factors and always get all of your questions answered ahead of time so that you know what to expect on the day of your surgery.
The doctors at UCF Health are here to help you navigate a new diagnosis and move forward with the unique treatment or services that work best for you. Find out if your insurance is taken at our facilities and get your paperwork complete ahead of time so that you can have a seamless visit. Schedule your consultation at a location near you today.