How is adrenal surgery performed?
The cortex is the part of the adrenal gland that makes cortisolCortisol - a glucocorticoid that controls glucose production and suppresses the immune system, a hormone that is crucial for life. If the patient does not have enough adrenal cortex left, he or she may develop adrenal insufficiency and may need to take steroid medication. (See What are the potential complications?) In cases of bilateral adrenal tumors (i.e. a tumor in both adrenal glands) or tumors that are small and clearly not cancer (like aldosteroneAldosterone - a mineralocorticoid that controls blood pressure producing adenomas), some surgeons may perform a cortical-sparing adrenalectomyCortical-sparing adrenalectomy - an operation to remove the part of an adrenal gland that has the tumor. Also called a partial adrenalectomy. to keep as much of this normal cortex as possible. This usually involves looking at the entire adrenal gland and cutting out just the tumor with a thin rim of normal tissue.
Figure 14: Cortical-sparing Adrenalectomy
Cortical-sparing adrenalectomy can be done through any of the laparoscopic or open approaches mentioned. However, it is unclear if it is of benefit to the patient when compared with the risk of potential cancer, recurrence rates (i.e. disease that comes back), and other potential complications. The decision whether it is safe to perform a cortical-sparing adrenalectomy should be made by an experienced adrenal surgeon.