What Are Adrenal Glands?
Adrenal glands are very small, triangular glands located at the tip of each kidney. The center of the gland is called the medulla, which is surrounded by the cortex. The medulla is responsible for production of epinephrine and norepinephrine, while the adrenal cortex is responsible for producing cortisol and aldosterone. These hormones control fluid and electrolyte balance in the body. In certain cases, tumors may form in the adrenal glands, with those located in the adrenal medulla possibly causing an increase in adrenaline, and those in the cortex resulting in an overproduction of hormones.
Most adrenal masses are found during a radiologic examination done for another reason. When an adrenal mass is found, additional work up is done to evaluate if the mass is cancerous or if it is secreting excess hormones. Less than 2% of all adrenal masses are cancerous. The larger the adrenal mass (more than 4 cm), the higher likelihood there is a cancer. There are also characteristics on imaging that help predict if the adrenal mass is cancerous. On occasion, a fine-needle aspiration biopsy may be performed. This can help tell the difference between a new adrenal cancer and a metastatic tumor. However, a fine needle aspiration cannot distinguish the difference between a non-cancerous adrenal mass and adrenal cancer. It is also important to rule out hormonally secreting tumors of the adrenal gland prior to biopsy.
About 10% of adrenal masses secrete excess hormones. There are three different types of hormones the adrenal gland can secrete in excess: cortisol (Cushing’s syndrome), aldosterone (Aldosteronoma) or norephinephrine (Pheochromocytoma). People with Cushing’s syndrome often have central obesity, high blood pressure, high cholesterol and diabetes. People with Aldosteronomas often have high blood pressure that is difficult to control with medications and sometimes have low potassium. People with a Pheochromocytoma may present with high blood pressure that is associated with headaches, sweating and palpitations. In each case, blood work and urinary analysis will help determine if the adrenal gland is responsible for the excess release of hormones.
How Can We Help?
If there is a known adrenal cancer or if adrenal mass is larger than 4 cm, we recommend removal. Patients with a Pheochromocytoma should also have the adrenal gland removed because untreated pheochromocytomas can have serious complications – even death. Most patients with an Aldosteronoma or Cushing’s Syndrome will also be offered surgery. In the case of Aldosteronoma, 95% percent of people have normal potassium levels after surgery and 75% of people no longer require medicine to lower blood pressure.
We typically remove the problematic adrenal gland laparoscopically using small incisions. An average stay in the hospital is 2-5 days. Exceptions to removing the adrenal gland laparoscopically include a large adrenal mass (more than 10 cm) or when the mass has invaded near-by structures. On occasion, people have adrenal masses in both adrenal glands. This situation requires additional testing. In the rare case that both adrenal glands need to be removed, medication is required for life to replace the hormones that the adrenal gland produces. If only one adrenal gland is removed, people do not usually have to take medicine.
Who to Contact
Dr. Charlie Jones and Dr. Susan Hagen are general, vascular and thoracic surgeons with over 30 years of experience. To make an appointment, please call 303-443-2123.