179:
385:, where several small cuts (incisions) are made to allow for the surgeon to directly control surgical instruments with their hands while visualizing the surgery via a tiny camera that provides a magnified, 3D view of the surgical site. Laparoscopic surgery has many benefits. For example, this surgery has smaller scars, less pain, less blood loss, similar complication rates, and a shorter recovery period than traditional open surgery. Traditionally, this has been through the laparoscopic transperitoneal approach (LTA) where the small cuts are made in the abdomen to reach the adrenal glands through the
239:
29:
158:
that are producing excess hormones or is large in size (more than 2 inches or 4 to 5 centimeters). Adrenalectomy can also be done to remove a cancerous tumor of the adrenal glands, or cancer that has spread from another location, such as the kidney or lung. Adrenalectomy is not performed on those who
392:
However, an alternative approach is possible called retroperitoneoscopic adrenalectomy (PRA), where the adrenal glands are reached through small cuts made in the back. Studies have shown that both LTA and PRA are equally safe and effective, though some suggest advantages of PRA over LTA in terms of
335:
guidelines state minimally-invasive techniques should be avoided when there is a large tumor size (larger than 6 cm) due to difficulties in maneuvering around a large mass, and in adrenocortical carcinoma where there is a risk of not fully removing the cancerous tissue. However, at least one
397:
suggests that laparoscopic retroperotenial adrenalectomy appears to reduce late morbidity, time to oral fluid or food intake and time to ambulation when compared to laparoscopic transperitoneal adrenalectomy; however, there is uncertainty about these effects due to very low-quality evidence. For
307:). These hormone-producing tumors may need adrenalectomy. Additionally, adrenal tumors that are larger than 4 centimeters in size, regardless of whether they produce hormones, also require adrenalectomy due to increased risk of adrenal cancer. Rarely (5–12%), the adrenal tumor may be cancerous (
409:
adrenalectomies. They perform the surgery through small cuts (incisions) using robotic arms with a camera and instruments attached. The camera gives doctors a high-definition, magnified, 3D view of the surgical site. No significant differences were found between laparoscopic and robot-assisted
442:, perioperative glucocorticoid therapy and postoperative assessment of HPA axis recovery are necessary. For patients who have undergone adrenalectomy for a pheochromocytoma, long-term followup is necessary because 10-15% of patients may have recurrence. For those with high blood pressure (
279:). Although these adrenal masses do require evaluation, the majority of them (approximately 80%) do not require adrenalectomy. However, due to the hormone-producing function of the adrenal glands, some noncancerous adrenal tumors may produce too much hormones, such as
327:(a reason not to do the surgery under any situation) for adrenalectomy are patients who are generally unsuited to surgery: having severe coagulopathy and poor cardiopulmonary performance due to the stress to the body that surgery will produce. In addition,
398:
outcomes such as all-cause mortality, early morbidity, socioeconomic effects, and operative and postoperative parameter, the evidence is uncertain about the effects of either interventions over the other. PRA involves high pressure COâ‚‚ within a limited
366:
Surgeons usually reserve open surgery for large (larger than 6 cm) or cancerous tumors where there is a risk of not fully removing the cancerous tissue. They perform open surgery using traditional instruments and cuts (incisions).
453:). Signs and symptoms include volume depletion, hypotension, hyponatremia, hyperkalemia, fever, abdominal pain. This requires lifetime treatment with the hormones produced by the removed adrenal glands, including glucocorticoids and
828:
Gan L, Meng C, Li K, Li J, Wu J, Li Y (August 2022). "Safety and effectiveness of minimally invasive adrenalectomy versus open adrenalectomy in patients with large adrenal tumors (≥5 cm): A meta-analysis and systematic review".
627:
Heger P, Probst P, HĂĽttner FJ, GooĂźen K, Proctor T, MĂĽller-Stich BP, et al. (November 2017). "Evaluation of Open and
Minimally Invasive Adrenalectomy: A Systematic Review and Network Meta-analysis".
410:
adrenalectomy in two meta-analyses for complications, blood loss, or mortality, however robotic adrenalectomy had shorter hospital stays at the cost of longer operating time and higher cost of surgery.
226:
and other essential functions. If one adrenal gland is removed, the other adrenal gland will take over the hormone-producing role. If both adrenal glands are removed, the patient will require lifelong
336:
meta-analysis of 898 patients has found shorter length of stay, less blood loss, and no higher rates of complications even in large (>5 cm) tumors using minimally-invasive techniques.
480:
replacement can be considered. The signs and symptoms include low libido, depressive symptoms, and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement.
175:
techniques. Minimally invasive techniques are increasingly the gold standard of care due to shorter length of stay in the hospital, lower blood loss, and similar complication rates.
765:
790:"The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas"
438:
has recovered. This process may take 6 to 18 months after unilateral adrenalectomy. Similarly, for patients who have undergone adrenalectomy for (subclinical)
1066:
1132:
328:
875:
Arezzo A, Bullano A, Cochetti G, Cirocchi R, Randolph J, Mearini E, et al. (Cochrane
Metabolic and Endocrine Disorders Group) (December 2018).
1016:
74:
70:
571:"Corticotroph tumor progression after bilateral adrenalectomy (Nelson's syndrome): systematic review and expert consensus recommendations"
435:
476:
For women with deficiency in androgens as a result of the loss of androgen production from the adrenal glands following adrenalectomy,
332:
1059:
967:"Predictive factors of clinical success after adrenalectomy in primary aldosteronism: A systematic review and meta-analysis"
1269:
1102:
1052:
315:, such as the kidney or lung. If the metastasis is isolated to the adrenal gland, it may be a candidate for adrenalectomy.
924:
Economopoulos KP, Mylonas KS, Stamou AA, Theocharidis V, Sergentanis TN, Psaltopoulou T, Richards ML (February 2017).
393:
lower intensity of postoperative pain, shorter hospital stay, faster recovery, and lower early morbidity. A 2018
163:
or whose heart and lungs are too weak to undergo surgery. The procedure can be performed using an open incision (
678:"The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial"
1203:
1165:
39:
1024:
449:
If both adrenal glands are removed, the patient can no longer create the adrenal hormones necessary for life (
418:
Postoperative care is highly dependent on what the adrenalectomy was performed for. After adrenalectomy for a
178:
676:
Kozłowski T, Rydzewska-Rosolowska A, Myśliwiec J, Choromańska B, Wojskowicz P, Dadan J, et al. (2019).
376:
349:
1264:
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1170:
1096:
276:
268:
1259:
1044:
505:
308:
81:
446:) from primary aldosteronism, adrenalectomy provides a clinical cure rate of approximately 27.1%.
1127:
877:"Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults"
527:"Leptin suppresses food intake and body weight in corticosterone-replaced adrenalectomized rats"
1220:
477:
443:
406:
172:
1208:
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Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, et al. (2009-07-01).
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238:
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450:
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8:
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Some of these effects are reportedly enhanced in bilaterally adrenalectomized (ADX) rats.
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462:
569:
Reincke M, Albani A, Assie G, Bancos I, Brue T, Buchfelder M, et al. (March 2021).
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Techniques for adrenalectomy is largely divided into two types: open surgical
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Gemmill ME, Eskay RL, Hall NL, Douglass LW, Castonguay TW (February 2003).
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926:"Laparoscopic versus robotic adrenalectomy: A comprehensive meta-analysis"
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for the procedure or resulting state) is the surgical removal of one (
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402:, and therefore may cause kidney injury in those at high risk.
191:
965:
Manosroi W, Atthakomol P, Phinyo P, Inthaphan P (2022-08-18).
422:-producing adenoma, patients should be treated with exogenous
874:
488:
Complications from an adrenalectomy can include insufficient
311:), requiring adrenalectomy. Rarer still, the mass may be a
787:
263:), often found incidentally as a mass via imaging such as
461:). The glucocorticoid dose needs to be increased when in
626:
568:
524:
313:
metastatic cancer that spread from another location
1133:Combined rapid anterior pituitary evaluation panel
182:Diagram showing the position of the adrenal glands
764:Data and references for pie chart are located at
329:American Association of Clinical Endocrinologists
1251:
370:
740:. Treasure Island (FL): StatPearls Publishing.
275:that were taken for other health workups (see
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881:The Cochrane Database of Systematic Reviews
827:
766:file description page in Wikimedia Commons.
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1053:
333:American Association of Endocrine Surgeons
27:
992:
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436:hypothalamic-pituitary-adrenal (HPA) axis
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259:Most adrenal tumors are noncancerous (
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381:Minimally invasive techniques may be
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138:“out-cutting”; sometimes written as
13:
16:Surgical removal of adrenal glands
14:
1281:
865:
818:
770:
718:
664:
611:
575:European Journal of Endocrinology
194:. The two adrenal glands produce
132:"related to the kidneys" + Greek
930:International Journal of Surgery
831:International Journal of Surgery
483:
413:
1009:
958:
917:
355:
154:. It is usually done to remove
1204:Dexamethasone suppression test
1166:Radioactive iodine uptake test
893:10.1002/14651858.CD011668.pub2
758:
562:
518:
233:
1:
511:
478:dehydroepiandrosterone (DHEA)
451:primary adrenal insufficiency
371:Minimally invasive techniques
339:
377:Minimally invasive procedure
242:Incidences and prognoses of
156:tumors of the adrenal glands
7:
1270:Surgical removal procedures
1103:digestive system procedures
499:
405:Sometimes surgeons perform
10:
1286:
1214:Captopril suppression test
1171:Sestamibi parathyroid scan
1097:Islet cell transplantation
971:Frontiers in Endocrinology
943:10.1016/j.ijsu.2016.12.118
843:10.1016/j.ijsu.2022.106779
374:
359:
252:
1229:
1186:
1143:
1113:
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984:10.3389/fendo.2022.925591
642:10.1007/s00268-017-4095-3
506:List of surgeries by type
246:; over half of which are
108:
94:
80:
64:
38:
26:
21:
630:World Journal of Surgery
531:The Journal of Nutrition
309:adrenocortical carcinoma
167:) or minimally invasive
1128:Transsphenoidal surgery
732:Li AY, Dream S (2022).
1221:Fluid deprivation test
444:secondary hypertension
250:
248:benign (noncancerous).
183:
1209:ACTH stimulation test
695:10.5603/EP.a2019.0029
682:Endokrynologia Polska
400:retroperitoneal space
389:from the front-side.
285:primary aldosteronism
241:
206:) that help regulate
181:
1176:TRH stimulation test
796:. 15 Suppl 1: 1–20.
544:10.1093/jn/133.2.504
587:10.1530/EJE-20-1088
494:acute kidney injury
803:10.4158/EP.15.S1.1
794:Endocrine Practice
455:mineralocorticoids
350:minimally invasive
297:Cushing's syndrome
251:
184:
1265:Surgical oncology
1247:
1246:
1158:Parathyroidectomy
1021:surgerydoor.co.uk
636:(11): 2746–2757.
395:systematic review
319:Contraindications
293:Cushing's disease
230:supplementation.
212:blood sugar level
119:
118:
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1260:Endocrine system
1081:endocrine system
1069:
1062:
1055:
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1023:. Archived from
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440:Cushing syndrome
325:contraindication
305:pheochromocytoma
200:steroid hormones
190:sits above each
112:edit on Wikidata
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1017:"Adrenalectomy"
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734:"Adrenalectomy"
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1123:Hypophysectomy
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1079:involving the
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471:adrenal crisis
432:hydrocortisone
415:
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407:robot-assisted
375:Main article:
372:
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360:Main article:
357:
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341:
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320:
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301:catecholamines
253:Main article:
244:adrenal tumors
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208:blood pressure
204:catecholamines
173:robot-assisted
152:adrenal glands
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1153:Thyroidectomy
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1027:on 2009-04-29
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60:for resection
59:
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51:for excision,
50:
46:
43:
41:
37:
33:Adrenalectomy
30:
25:
22:Adrenalectomy
20:
1239:Pinealectomy
1231:Pineal gland
1195:
1041:
1029:. Retrieved
1025:the original
1020:
1011:
974:
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960:
933:
929:
919:
884:
880:
834:
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749:. Retrieved
737:
685:
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629:
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534:
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492:production,
487:
475:
448:
417:
404:
391:
383:laparoscopic
380:
365:
356:Open surgery
352:techniques.
343:
323:An absolute
322:
258:
185:
169:laparoscopic
161:coagulopathy
159:have severe
139:
133:
128:"near/at" +
124:(Latin root
121:
120:
473:may occur.
281:aldosterone
234:Indications
146:) or both (
96:MedlinePlus
1254:Categories
1077:procedures
1031:2021-12-04
977:: 925591.
936:: 95–104.
837:: 106779.
751:2022-11-22
738:StatPearls
512:References
467:infections
465:or during
434:until the
387:peritoneum
362:Laparotomy
346:laparotomy
340:Techniques
273:ultrasound
216:metabolism
165:laparotomy
144:unilateral
40:ICD-10-PCS
1115:Pituitary
1101:see also
1075:Test and
859:250937601
712:195806068
428:cortisone
148:bilateral
1089:Pancreas
1003:36060937
952:28043926
911:30595004
851:35870758
812:19632967
746:32644519
704:31274187
650:28634842
605:33444221
553:12566491
500:See also
490:cortisol
469:or else
426:such as
420:cortisol
303:(called
291:(called
289:cortisol
283:(called
265:CT scans
196:hormones
66:ICD-9-CM
1145:Thyroid
994:9434311
902:6517116
658:4729192
596:8060870
348:versus
228:steroid
135:‑ectomy
88:D000315
1200:Tests
1162:Tests
1001:
991:
950:
909:
899:
857:
849:
810:
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463:stress
299:), or
261:benign
224:stress
192:kidney
102:007437
855:S2CID
708:S2CID
654:S2CID
271:, or
130:renal
110:[
999:PMID
948:PMID
907:PMID
885:2018
847:PMID
808:PMID
742:PMID
700:PMID
646:PMID
601:PMID
549:PMID
331:and
202:and
186:One
82:MeSH
75:07.3
71:07.2
58:0GT4
54:0GT2
49:0GB4
45:0GB2
989:PMC
979:doi
938:doi
897:PMC
889:doi
839:doi
835:104
798:doi
690:doi
638:doi
591:PMC
583:doi
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539:doi
535:133
430:or
295:or
287:),
269:MRI
171:or
140:ADX
1256::
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928:.
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895:.
883:.
879:.
867:^
853:.
845:.
833:.
820:^
806:.
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