The American Association of Endocrine Surgeons, Patient Education Site

Adrenal Glands: Frequently Asked Questions

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What is the pancreas?
What is the pituitary gland?
What is a Whipple procedure?
What is a pancreatic enucleation procedure?
What are the risks of pancreatic surgery?
Is a carcinoid tumor cancer?
What is the adrenal gland?
Which hormones do the adrenal glands make?
What is the function of aldosterone?
What is cortisol?
What are the side effects of excessive cortisol?
What can I do to lower my cortisol level?
What happens when the adrenal glands malfunction?
Does my small adrenal tumor need to be removed?
What should I expect after adrenal surgery?
What type of anesthesia will I need for my adrenal surgery?
How can I find an experienced adrenal surgeon?
Will I need a drain after my adrenal surgery?
What are the most important complications that may occur after adrenal surgery?
How long does the surgery to remove the adrenals take?

What is the pancreas?

The pancreas is an organ involved in both digestive (exocrine) and metabolic (endocrine) processes required to maintain normal bodily function. The digestive function of the pancreas involves the release of digestive enzymes into the intestines, allowing food to be broken down into fats, proteins, and carbohydrates that can then be absorbed into the body. The endocrine function of the pancreas involves secretion of hormones such as insulin, gastrin, glucagon, somatostatin, and vasoactive intestinal peptide which help regulate blood sugar levels, stomach acid secretion and other endocrine functions.

The pancreas lies roughly in the center of the abdomen. It is located between the beginning of the small intestine (to the right), and spleen (to the left). It is behind the stomach and in front of the major blood vessels of the body, the aorta and vena cava.

What is the pituitary gland?

The pituitary gland is a small gland located directly behind the nose inside the skull. The pituitary gland helps regulate the function of many other endocrine glands located throughout the body. These hormones are involved in a wide range of activities, including growth and metabolism, salt and blood pressure regulation, sexual maturation and reproduction, and milk production.

Tumors in the pituitary gland can lead to excess hormone production or create pressure on nearby structures.

What is a Whipple procedure?

The Whipple operation (pancreaticoduodenectomy) is an operation designed to remove tumors in the head of the pancreas, ampulla of Vater, duodenum, and bile duct. This involves division of the stomach, small intestine, pancreas, and bile duct, as well as separation of the pancreas and duodenum from adjacent blood vessels. The intestines are then reconnected to the pancreas, bile duct, and stomach, in a way to allow for normal intestinal continuity and function after the operation.

For more information, see: Pancreatic neuroendocrine tumors: gastrinoma

What is a pancreatic enucleation procedure?

A pancreatic enucleation procedure is an operation designed to remove small, well-defined tumors of the pancreas. This procedure involves "shelling out" the tumor from the surrounding pancreas. A drain is often left over the area of the pancreas where the tumor was removed. Depending on the location of the tumor, the operation can sometimes be performed laparoscopically.

This approach differs from a pancreatic resection procedure (e.g., Whipple procedure, distal pancreatectomy, central pancreatectomy), which involves division and removal of a portion of the surrounding pancreas and tumor.

For more information, see: Pancreatic neuroendocrine tumors: insulinoma

What are the risks of pancreatic surgery?

The pancreas is located next to many important structures and major blood vessels in the body. Complications of enucleation procedures and distal pancreatectomy include bleeding, infection and abscess formation, injury to nearby structures (e.g., spleen, stomach, colon, small intestine), diabetes, and fluid leak from the pancreatic duct. Pancreatic leaks are controlled with drains and will often resolve over time on their own.

In addition to the above, the Whipple (pancreaticoduodenectomy) procedure has added risks of delayed emptying of the stomach, as well as leaks or strictures at any of the new connections between the intestine and the pancreas, bile duct, or stomach.

For more information, see: Pancreatic neuroendocrine tumors: insulinoma

Is a carcinoid tumor cancer?

Carcinoid (originally termed "karzinoide " by a German pathologist) refers to the "carcinoma-like" feature of these tumors which tend to clinically behave like benign tumors, but have a malignant appearance when viewed under a microscope. Cancers in general are characterized by unregulated growth, tissue invasion, and ability to grow in distant sites of the body (metastasis). Since even very benign behaving carcinoid tumors have the ability to invade other tissues and metastasize to distant organs, they should be treated as low-grade cancers. In general, carcinoid tumors are well-differentiated, slow-growing, and behave in a fairly benign fashion; however, some carcinoid tumors are very aggressive and can spread to many other areas of the body.

Carcinoid tumors can secrete a variety of substances, including serotonin and histamine. Large amounts of these substances can cause flushing, diarrhea, wheezing, and heart valve dysfunction ("Carcinoid Syndrome").

For more information, see:
Background: Neuroendocrine tumor/carcinoid tumor features
Small bowel carcinoids
Pulmonary carcinoid
Gastric carcinoids

What is the adrenal gland?

The adrenal glands are two small glands that are several centimeters in length (about the size of your thumb), which sit above each kidney in the back of the abdomen. The adrenal glands are responsible for making hormones that control blood pressure and respond to physical stress (fight or flight response), and still others that make us male and female.

For more information, see: Background: Function of the adrenal glands

Which hormones do the adrenal glands make?

The adrenal gland makes a number of different hormones. The outer layer – cortex - produces mineralocorticoids (e.g. aldosterone), glucocorticoids (e.g. cortisol), and sex steroids (e.g. testosterone and progesterone). The inner layer – medulla - produces catecholamines (e.g. epinephrine, also known as adrenaline, and norepinephrine, also known as noradrenaline).

For more information, see: Background: Function of the adrenal glands

What is the function of aldosterone?

Aldosterone affects sodium, potassium, total fluid in the body, and blood pressure. Aldosterone causes the kidneys to hold onto more sodium, which leads to more water staying in the body. The more fluid the body holds onto, the higher the blood pressure may become. Potassium may decrease as the amount of aldosterone increases. Aldosterone also directly affects the heart and blood vessels.

For more information, see: Background: Function of the adrenal glands

What is cortisol?

Cortisol, a steroid, has three main functions. It causes the liver to produce sugar and causes break down of muscle and fat to create this sugar. Cortisol also helps the body regulate its response to stress. Lastly, cortisol decreases inflammation and decreases the immune system response. Excess steroids can lead to Cushing's syndrome, obesity, diabetes, high blood pressure, weak muscles, characteristic bodily changes, and brittle bones.

For more information, see: Background: Function of the adrenal glands

What are the side effects of excessive cortisol?

Too much cortisol, known as Cushing's syndrome, can have unwanted side effects in the form of obesity, diabetes, muscle weakness and breakdown, change in distribution of fat in the body (skinny arms and legs, big belly), thin skin, striae (purple lines on the abdomen similar to stretch marks), and brittle bones leading to osteoporosis and fractures. Depression, memory problems, and cataracts can also result from excess cortisol. Growth and puberty can be interrupted in children. Females can have difficulty getting pregnant. People with too much cortisol are also at increased risk for infection and may not heal wounds well.

For more information, see: Cushing's syndrome (cortisol-producing adrenal tumor)

What can I do to lower my cortisol level?

Depending on the cause of your excess of cortisol, medical or surgical treatment may be appropriate. The most common cause of too much cortisol is taking medications that contain cortisol. These medicines are usually prescribed for inflammatory problems (e.g. asthma, arthritis), skin disorders (topical steroids/creams), or auto-immune problems (e.g. lupus). The best way to lower your cortisol level in these cases is to work closely with your doctor to only take glucocorticoid-containing medicines when absolutely necessary, take the minimum amount necessary, and to switch, when possible, to non-steroid containing medications that can treat your condition.

Chronic stress, alcohol and caffeine use are all things that can increase your cortisol level. Regular exercise, healthy attitudes and approaches to dealing with stress, and moderation of alcohol and caffeine intake can all lower your cortisol level.

If surgery is required, removal of a tumor in the pituitary gland, removal of an ACTH producing tumor elsewhere in the body, or removal of one and sometimes both of the adrenal glands can take care of excess cortisol levels.

For more information, see: Cushing's syndrome (cortisol-producing adrenal tumor)

What happens when the adrenal glands malfunction?

Adrenal glands that malfunction can either produce too little or too much hormone. Too few hormones (adrenal insufficiency, also known as Addison's disease) can be fatal and patients must take medications to supplement their low hormone levels. Too much hormone can lead to a variety of effects depending on which hormone is being over-produced. Too much aldosterone can lead to high blood pressure and dangerously low potassium levels. Too much cortisol can lead to Cushing's syndrome. Too much testosterone can lead to females developing male characteristics (e.g. deeper voice, increased body hair). Too much adrenaline can lead to high blood pressure, a heart attack, or stroke.

For more information, see:
Primary hyperaldosteronism (Conn's syndrome or aldosterone-producing adrenal tumor)
Cushing's syndrome (cortisol-producing adrenal tumor)
Pheochromocytoma (adrenaline-producing adrenal tumor)
Sex hormone-producing adrenal tumor

Does my small adrenal tumor need to be removed?

With the increasing use of CT scans and MRI, doctors are more likely these days to find small adrenal tumors (generally less than four centimeters in size) that they otherwise would not have known about (incidentaloma). As patients get older, they are more likely to have one of these small adrenal tumors. Most small adrenal tumors, unless they have suspicious imaging features, do not need to be removed. Your doctor should also obtain blood and/or urine tests to make sure the tumor is not producing excess hormones. You should also receive age-appropriate health screening to ensure that a small adrenal tumor is not a cancer that has spread from somewhere else (metastasis). Finally, small adrenal tumors that grow significantly over a short period of time may need to be removed. A repeat CT scan or MRI should be obtained six to twelve months after your first scan to make sure the tumor is not getting bigger.

For more information, see: Adrenal incidentaloma

What should I expect after adrenal surgery?

After laparoscopic adrenalectomy, many patients may be discharged from the hospital as early as the day after surgery. After open adrenalectomy, the hospital stay is longer and averages 4-5 days. The ability to eat may be delayed for several days after open adrenalectomy until the bowels start moving again. Patients may shower 48 hours after surgery. Heavy lifting or vigorous activity should be avoided for at least 4 weeks to decrease the chance of wound complications and formation of a hernia, but patients will be encouraged to get up and walk as soon as possible. The overall recovery time for open adrenalectomy is significantly longer than for laparoscopic surgery.

For more information, see: Adrenal Glands: How is adrenal surgery performed?

What type of anesthesia will I need for my adrenal surgery?

All adrenalectomies are performed under general anesthesia. Some patients who undergo an open adrenalectomy may have an epidural placed which helps decrease pain after surgery. For those undergoing laparoscopic surgery, local anesthetic (numbing medicine) is usually injected at the incision sites to help with pain. Often, a pain pump (PCA - patient controlled analgesia) is provided to the patient for the first couple of days so they may administer their own pain medication as needed.

For more information, see: Adrenal Glands: How is adrenal surgery performed?

How can I find an experienced adrenal surgeon?

Click on the "Find a Surgeon" tab on the AAES Patient Education Site. In general, a surgeon should do more than 20 adrenal operations a year to be considered an expert. Surgeons with experience operating on adrenal cancer are few, and patients with possible adrenal cancer should research this carefully prior to surgery with the help of their endocrinologist or primary care physician. Patients should not be shy or embarrassed to ask how many adrenal operations a surgeon has done and what their complication rate is. Be wary of surgeons or websites that make extravagant claims about experience and success or make insulting comments about other surgeons or physicians. Check with your endocrinologist or primary care physician for recommendations of an experienced adrenal surgeon in your area or around the country.

For more information, see: Adrenal Glands: How do I find an experienced adrenal surgeon?

Will I need a drain after my adrenal surgery?

Patients rarely require drains after adrenal surgery; however, if the surgeon thinks it is necessary, an abdominal drain will be placed. Drains are more often required after open adrenalectomy than after laparoscopic adrenalectomy. Drains are relatively easy to take care of, and the output is recorded on a daily basis. Once the output decreases to a certain level, the drain will be removed. Removal of the drain is not particularly painful. It is more of a strange sensation. In general, the drain will be removed several days after surgery.

For more information, see: Adrenal Glands: How is adrenal surgery performed?

What are the most important complications that may occur after adrenal surgery?

Pneumonia, wound infections, bleeding, need for blood transfusions, and blood clots (deep vein thrombosis or pulmonary embolus) are rare, but may occur after adrenal surgery. Damage to other nearby organs may occur, but this is also rare. Adrenal insufficiency is a potentially life-threatening complication that may occur in patients who had surgery for Cushing's syndrome or Cushing's disease, or who had both adrenal glands removed if not enough cortisol is produced for the body after surgery. Symptoms of this condition include feeling generally unwell, nausea, vomiting, and confusion. Patients may need steroid medications. It is recommended that patients obtain and wear a medical alert bracelet or other device to alert medical personnel that an adrenal gland has been removed and they may require steroids as a lifesaving measure.

For more information, see: Adrenal Glands: How is adrenal surgery performed?

How long does the surgery to remove the adrenals take?

The length of time spent in surgery for adrenalectomy can vary greatly. On average, both laparoscopic and open operations last approximately 1.5-3 hours; however, the procedure can be longer depending on a variety of factors. Your surgeon will discuss this with you at the time of your appointment and provide you with a more accurate estimate based on the specifics of your case.

For more information, see: Adrenal Glands: How is adrenal surgery performed?


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