Adrenal Tumors

General Information

• The two adrenal glands regulate minerals and hormones in your body. Each gland is about 1 and 1 /2 inches long and wide and 1 /2 inch thick. They sit on top of either kidney. The cause of adrenal tumors is not known.

Common Signs and Symptoms

Because the adrenal glands have a number of different functions, the symptoms the tumors produce depend a lot on which of these functions is disturbed. The types of tumors are as follows:

• Adenoma: These often do not produce any symptoms.
• Aldosteronoma: These are not cancerous but can cause high blood pressure and serious changes in the chemicals in your body.
• Pheochromocytoma: These mostly are benign tumors that are dangerous because they can produce very severe blood pressure problems as follows: a constant high blood pressure; a sudden attack of very high blood pressure that may last for just a few minutes or for several hours; ''pounding'' headache; sweating; fast pulse; severe nervousness; trembling; nausea; weakness, even death; or stroke.
• Cancer: The adrenal mass can be cancerous.

Diagnosis

• A detailed history will be taken, and a thorough physical examination will be done. You will have some, and possibly all, of the following tests: 
• Measurements of hormones and chemicals in your blood and urine to determine the exact nature of the mass.
• CT scan (computed tomography scan): These special x-rays are taken by a machine that is shaped like a huge doughnut. You will lie on a table inside the hole in the ''doughnut.'' The x-rays are taken as very thin slices through the upper abdomen. This makes it possible to see the size and shape of the adrenal glands and surrounding tissues.
• MRI (magnetic resonance imaging): No x-rays are used with this technique. Instead, it is done with harmless magnetic fields and radio waves. A computer develops the pictures to show organs from several angles.
• Adrenal scintigraphy: This is a special way to locate masses in the adrenal glands.

Treatment

Some conditions of the adrenal glands can be treated with medicine, and others require an operation. An operation can be the main treatment for the following:

• Adenoma: Many adenomas do not cause any problems and are not dangerous. They can be observed carefully as long as they remain smaller than a walnut and show no signs of being cancerous.
• Aldosteronoma: The symptoms can be cured by removing the tumor.
• Pheochromocytoma: Removal by an operation is only treatment. If these tumors are not removed, practically all patients die from the complications caused by heart and blood pressure problems.
• Cancer: The best chance for cure is to remove the tumor completely by performing an operation.

Preparing for Surgery

• Any associated problems will be corrected as much as possible before the operation.
• Do not eat or drink anything for 8 hours before your operation.
• If you are taking medicine to control blood pressure, be certain the doctors know about this.
• You may be given medicine that will make you feel drowsy before you are brought into the operating room.

The Operation

• You will be asleep during this operation.
• A number of wires will be taped to your skin so that your heart rate and other functions can be followed during the operation.
• Operations for adrenal tumors are usually performed with laparoscopes (This technique is less painful and the recovery is faster.) The laparoscopes are as big around as the tip of your little finger. Three or four laparoscopes will be placed in your abdomen through very short incisions, and the entire operation is performed using them. Occasionally, however, when everything inside is examined with the laparoscope, conditions are such that it is not possible to do the operation this way. If that is the case with you, an open incision will have to be made. The adrenal gland then can be removed through an incision on the abdomen, the flank, or the back. The type of incision is determined by the size and type of tumor that is to be removed, the build and condition of the patient, and the surgeon's preference. This will be discussed with you before the operation.
• It may be absolutely necessary that you receive blood transfusions.
• The operation generally takes about 3 hours.

Following Surgery 

• You will be taken to the Surgical Care Unit, where the doctors and nurses are very experienced in taking care of patients like yourself. When you are doing well enough, you will be transferred to a regular hospital room. · That evening you will be able to get out of bed with assistance.
• Pain will be controlled with medicine.
• Your diet will be as you tolerate it.
• Your length of stay in the hospital will depend on where the incision was made and what type of tumor was removed.
• As with any operation, complications are always possible. Although they are uncommon with this type of operation, they can include bleeding, infection, lung problems, or continued blood pressure problems.

At Home After Surgery

• You may walk about as you wish, even climb stairs, but don't overdo it; take frequent rests.
• You may eat as you wish.
• Take medicine as prescribed for your pain.
• You may shower if you wish, with any dressings on or off. There may be narrow strips of tape across the incision. It's all right if they get wet; they will be removed in the doctor's office. After you dry yourself, replace any dressings with clean, dry ones.
• Do not drive if you cannot move freely or are taking medicines that decrease your alertness.
• You may resume sexual activity whenever you choose.
• You may return to work when you feel up to it.

Call our office if...

• You suddenly feel weak or lightheaded.
• You have new or unusual symptoms.
• The incision becomes red or swollen, or there is drainage from it.
• You develop a temperature higher than 101.7F.
• You have any questions.