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Overview

 


Adrenal Tumors


Tumors of the adrenal glands can be either malignant (cancer) or benign (non-cancer). These tumors can cause different symptoms.

Some patients are diagnosed with primary hyperaldosteronism. In 80% of these patients it is caused by an adenoma (benign tumor) in the adrenal cortex that releases too much aldosterone. Symptoms may include high blood pressure, low blood potassium levels and muscle weakness.

Cushing’s syndrome, or an excessive production of glucocorticoids, is also caused by an adrenal cortex tumor. Symptoms may include moon face (round, puffy face), buffalo hump (an increase in fat pads just below the back of the neck), truncal obesity (increase in weight around the abdomen), wasting of your muscles, easy bruising, facial hair, purplish “stretch marks” on your abdomen, high blood pressure and changes in emotions from feelings of high to low.

Another type of adrenal tumor is called a pheochromocytoma. Pheochromocytomas are usually located in the adrenal medulla. About 85- 90 % occur at random, but some may occur in families. Symptoms can include headache, sweating, palpitations (rapid heart beats), and high blood pressure.  There will also be high levels of catecholamines (epinephrine and norepinephrine) in the urine and blood.


Signs of Infection


Temperature greater than 100 degrees F for more than 24 hours Swelling, tenderness, redness, unusual drainage from your incisions

Nausea, vomiting, or shaking chills When to Call the Surgeon—Contact your surgeon for any signs of infection or if your pain is not controlled by your pain medications


Tumor


  • T1 - Tumor confined to adrenal gland and less than 5 cm
  • T2 - Tumor confined to adrenal gland and greater than 5 cm
  • T3 - Tumor invasion into periadrenal fat
  • T4 - Tumor invasion of adjacent organs


Node


  • N0 - Negative lymph nodes
  • N1 - Positive lymph nodes


Metastases


  • M0 - No metastases
  • M1 - Distant metastases

History of the Procedure: The adrenal gland is crucial to endocrine homeostasis, and maladies associated with it result in several recognized syndromes. Understanding of the adrenal glands began in 1805, when Currier first delineated the anatomic structure of the medulla and cortex. Addison later described the clinical effects of adrenal insufficiency in 1855. Thomas Addison first described the association of hypertensive episodes with adrenal tumors in 1886. Medical and surgical management of pheochromocytoma was first described in the United States by Mayo and remained relatively unchanged until the 1960s, when Crout elucidated the biochemical pathways and diagnostic catecholamine studies, allowing diagnostic ability prior to exploration.
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Before surgery


Once the surgery has been scheduled, arrangements will be made for your pre-operative evaluation by your surgeon’s secretary.  You will meet with a nurse practitioner or physician’s assistant in the Preoperative Evaluation Area at the Johns Hopkins Outpatient Center.  The pre-op evaluation can include a history and physical, laboratory studies, chest x-ray, a urine test and EKG.

A bowel preparation is also necessary 48 hours prior to your surgery. Purchase Fleets Prep Kit # 1 with phospho-soda and follow the directions. This may be purchased without a prescription at the pharmacy counter of your local drug store. You will also be on a clear liquid diet 24 hours before surgery. This includes Jell-O, broth, Popsicle, tea, coffee, and soda. You should not drink milk, cream, milkshakes, orange or tomato juice, cream soups or oatmeal. Prior to surgery, you may be prescribed medications for your blood pressure. It is important to take them as directed. If you take aspirin or nonsteroidal anti-inflammatory agents you should stop taking these one week before surgery.  The night before surgery, do not have anything to eat or drink after midnight.


Adrenal Surgery


Most adrenal tumors can be removed by a surgical procedure called laparoscopic adrenalectomy. In a small number of patients it may be necessary to convert a laparoscopic adrenalectomy to an open adrenalectomy. For some patients, an open adrenalectomy may be preferable initially. Your surgeon will explain your specific surgery and why it is recommended in your case.

As with any surgical procedure, there are risks involved.  There is a risk of bleeding and extreme changes in blood pressure.  The risk of infection is so low that antibiotics are not routinely used.  There is also a very low risk of pneumonia, injury to bowel, spleen, pancreas or liver.  There is also a small risk associated with anesthesia.  However, the relative risk of complications is very low and is usually outweighed by the potential benefits of having the surgery. Your surgeon will go over this information with you and answer any questions you might have.






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