Adrenal glands are two small glands located on top of the kidney. These glands normally produce hormones such as cortisol, aldosterone, dehydroepiandrosteron (DHEAS) epinephrine, nor-epinephrine and dopamine.
The adrenal gland is made up of two parts – the outer cortex and the inner medulla. Adrenal tumours can affect either of these two regions. The type of adrenal tumour depends on its region of origin.
Adrenal tumours are sometimes found on scans done for evaluation of other problems. They may also be found on evaluation for specific problems such as young onset or severe hypertension, Cushing’s syndrome or abdominal pain.
Two questions to be answered in every adrenal tumour include
Whether the tumour is
- Functioning/ non-functioning i.e. producing hormones or silent
- Cancer/ benign
Adrenal gland disorders which require surgery include
- Pheochromocytoma – It is a tumour which produces excess adrenaline and noradrenaline. This leads to high blood pressure with alarming symptoms like palpitation, severe headache and drenching sweats. Some patients with this disorder can have a genetically inherited problem such as MEN 2 syndrome and Von Hippel Lindau syndrome. Treatment requires an experienced team of endocrinologists and endocrine surgeons. The patient is initially treated with appropriate anti hypertensive agents and is carefully prepared for surgery in order to avoid complications
- Cushing’s syndrome – Some patients can have a tumour producing excess of the steroid cortisol. Patients can have increased weight gain, depression, stretch marks, buffalo hump, easy bruisability, increased sugars, high blood pressure etc.
- Conns syndrome – These patients have a tumour producing excess of the salt retaining hormone aldosterone. They have high blood pressure and low potassium levels due to an increase in aldosterone. Treatment is surgical removal of the adrenal tumour.
- Adrenocortical cancer - It’s a rare cancer, patients can have large swelling in the abdomen with or without pain. Around 60% of these tumours secrete various hormones like cortisol, DHEAS etc.
Other tumours or masses that are occasionally seen
- Adrenal myelolipoma
- Adrenal cysts
- Infection – such as tuberculosis and histoplasmosis
Adrenal surgery can be done by both endoscopic/ retroperitonioscopic and open techniques. The type of surgery preferred depends on the size and extent of the tumour.
Some patients may, especially those with genetically inherited tumours may require removal of both their adrenal glands. Such patients will need to take steroid supplements following surgery.