Conditions Treated With Adrenal Surgery
Adrenal Glands – Anatomy, Function, and Clinical Importance
The adrenal glands are two small but vital endocrine glands located deep in the abdomen, behind the lining of the abdominal cavity (retroperitoneum), sitting just above each kidney. The right adrenal gland lies behind the liver, next to the inferior vena cava, and on top of the right kidney; while the left adrenal gland sits beside the aorta, behind the pancreas, and above the left kidney. Each adrenal gland has two distinct parts with different functions the adrenal cortex and the adrenal medulla.
Adrenal cortex
Produces essential steroid hormones and is divided into three zones. The zona glomerulosa produces aldosterone, which regulates blood pressure and salt balance. The zona fasciculata produces cortisol, a key hormone for metabolism, immune regulation, and the body’s response to stress. The zona reticularis produces adrenal androgens, which contribute to sexual development and hormonal balance.
Adrenal Medulla
This area lies at the centre of the gland and produces catecholamines—including adrenaline (epinephrine) and noradrenaline (norepinephrine)—which drive the body’s “fight or flight” response. These hormones increase heart rate, blood pressure, and blood glucose during physical or emotional stress.
Pheochromocytoma and Paraganglioma
These are rare catecholamine-producing tumours arising from the adrenal medulla or extra-adrenal paraganglia. Symptoms often include episodic or resistant hypertension, headaches, palpitations, sweating, and anxiety attacks. Diagnosis involves plasma or urinary metanephrines, followed by dedicated adrenal CT or MRI. Treatment includes careful pre-operative alpha-blockade, with beta-blockers added when needed, followed by laparoscopic adrenalectomy for localised disease.
Primary Aldosteronism (Conn Syndrome)
Primary aldosteronism is caused by excess aldosterone production, leading to high blood pressure, low potassium levels, and increased cardiovascular risk.
Assessment includes the aldosterone–renin ratio, confirmatory testing, and adrenal imaging. Adrenal vein sampling is often required to confirm unilateral disease. Unilateral laparoscopic adrenalectomy is recommended when disease is confined to one adrenal gland; medical therapy is used for bilateral disease or non-surgical candidates.
Cushing Syndrome and Autonomous Cortisol Secretion
Cortisol-producing adrenal tumours cause weight gain, diabetes, hypertension, muscle weakness, osteoporosis, and skin changes.
Diagnosis includes dexamethasone suppression testing, late-night salivary cortisol, 24-hour urinary cortisol, and adrenal imaging. Laparoscopic adrenalectomy is the treatment of choice for unilateral disease. Patients require careful perioperative and postoperative steroid management.
Adrenocortical Carcinoma
Adrenocortical carcinoma is a rare but aggressive adrenal cancer, often presenting as a large adrenal mass, sometimes with hormone excess or abdominal pain.
Management requires open adrenalectomy with en bloc resection, performed in experienced, high-volume centres. Advanced cases may require mitotane or systemic therapy as part of a multidisciplinary cancer treatment plan.
Non-Functioning Adrenal Masses
Most small, non-functioning adrenal nodules are benign. Surgery is recommended for lesions ≥4 cm, those with concerning imaging features, or tumours that increase in size over time. Benign-appearing lesions <4 cm generally do not require surgery or long-term follow-up.