Overview
A small gland with outsized effects.
The adrenal glands are two small, triangular hormone factories that sit on top of the kidneys. When working normally, they regulate blood pressure, salt balance, the stress response, and a small portion of sex-hormone production. When a tumor develops on the gland, it can either produce too much hormone — causing severe hypertension, panic-attack-like spells, weight gain, low potassium, or other symptoms — or simply enlarge in a way that raises concern for cancer. Adrenalectomy is the operation that removes the abnormal gland (almost always one side; very rarely both).
For the great majority of patients, we remove the adrenal gland minimally invasively, through three or four small incisions in the flank or upper abdomen. We use a laparoscopic transabdominal approach for most tumors and a posterior retroperitoneoscopic approach for selected smaller tumors. Cancer suspected on imaging or biochemistry, very large tumors, and tumors invading neighboring structures usually require an open operation. The most important pre-operative step in any adrenal case is biochemical testing — we never operate on a hormone-producing tumor without knowing exactly which hormone it makes.
Who is a candidate?
We recommend adrenalectomy for biochemically confirmed pheochromocytoma, aldosteronoma, and cortisol-producing adenoma; for adrenal masses 4 cm or larger; for masses with worrisome imaging features regardless of size; for solitary metastases to the adrenal where surgery is part of a multidisciplinary cancer plan; and for primary adrenal cortical carcinoma. Smaller, hormonally inactive masses with reassuring imaging are followed rather than removed. The decision depends on the specific tumor type, the patient's overall health, and the imaging — every case is individualized in our office.
How we perform it
Under general anesthesia, you are positioned on your side. Three or four small ports are placed and the abdomen insufflated with carbon dioxide. We carefully separate the adrenal gland from the liver (right side) or spleen (left side), the diaphragm, and the kidney. The adrenal vein is identified, ligated, and divided early — particularly important in pheochromocytoma to minimize catecholamine release. The remaining tissue around the gland is sealed and divided, and the gland is placed in a retrieval bag and removed through one of the incisions. Most operations take 90–180 minutes depending on tumor size and surrounding anatomy.
Recovery
Most patients spend one to two nights in the hospital. You will walk the evening of surgery, eat a light diet, and have routine blood pressure monitoring — especially important after pheochromocytoma surgery, when blood pressure can drop in the first 24 hours. Desk work resumes at 7–10 days, full activity at 2–4 weeks. Patients operated for Cushing's syndrome need temporary stress-dose steroid coverage until the remaining gland recovers, which we coordinate with your endocrinologist. Follow-up at 1–2 weeks in our Coral Springs office.
Why Florida Surgical
Adrenal surgery sits at the intersection of endocrinology, anesthesia, and minimally invasive technique. The pre-operative work-up — alpha-blockade for pheochromocytoma, aldosterone–renin ratios for Conn's, low-dose dexamethasone suppression for Cushing's — is as important as the operation itself. Dr. Shaw and Dr. Decio coordinate every case with the referring endocrinologist, use the right surgical approach for the right tumor, and perform the operation at hospitals where the anesthesia teams are experienced with adrenal-specific intraoperative blood-pressure management.
Frequently asked questions
Can I live with one adrenal gland?
Yes. The remaining adrenal gland produces enough cortisol, aldosterone, and other hormones for a normal life. Patients who have both glands removed (rare) need lifelong cortisol and mineralocorticoid replacement.
Why does pheochromocytoma need special preparation?
Pheochromocytomas release surges of adrenaline that can cause dangerous blood pressure spikes during anesthesia and surgery. We start alpha-blockade — usually phenoxybenzamine or doxazosin — at least two weeks before surgery to stabilize blood pressure. Beta-blockers are added only after adequate alpha-blockade. We coordinate this carefully with your endocrinologist.
How long is recovery?
Most patients are home in 1–2 days after minimally invasive adrenalectomy, back to desk work in 1–2 weeks, and at full activity by 3–4 weeks. Open adrenalectomy — needed for some cancers — takes 4–6 weeks of recovery.
Will my blood pressure improve after surgery?
For pheochromocytoma and aldosteronoma, the great majority of patients see blood pressure normalize or improve dramatically. Aldosteronoma patients often see potassium levels normalize within days. Some patients require ongoing medication at much lower doses; long-standing hypertension can leave behind some baseline blood-pressure elevation even after the tumor is removed.
Do I need steroids after surgery?
Yes — patients having an adrenalectomy for Cushing's syndrome need temporary stress-dose steroids, sometimes for months, until the remaining adrenal gland recovers from being suppressed by the tumor. We taper steroids slowly with your endocrinologist. Patients with non-cortisol-producing tumors do not need steroid replacement.