14 February, 2025

Surgery for adrenal gland tumors with functional preservation: Better quality of life

Adrenal gland tumors can affect hormone production and have a significant impact on health. While most cases involve a benign adrenal tumor, its growth or hormonal activity may require surgical treatment. In this article, we will discuss the symptoms of adrenal tumors, treatment options, and what life without adrenal glands is like after surgery.

What are the adrenal glands and what is their function?

The adrenal glands are endocrine organs located above the kidneys, protected by the spine, ribs, and abdominal viscera. Despite their small size, they play a crucial role in producing essential hormones for:

• Regulating blood pressure and body temperature.
• Controlling the sleep cycle, appetite, and mood.
• Managing the response to stress and emotions.
• Contributing to sexual development and function.

Any alteration in adrenal function can lead to health problems that affect the patient’s quality of life.

Diseases and tumors in the adrenal gland

The adrenal glands can develop various pathologies, including:

• Benign adrenal tumors larger than 4 cm.
• Adrenal tumors that produce hormones in excess (functional).
• Adrenal carcinoma or malignant tumors.
• Metastasis from other cancers.

Although some cases can be treated with medication, surgery is often necessary to avoid serious complications.

What is an adrenal gland tumor and when should it be operated on?

Adrenal gland tumors can be benign or malignant, functional (when they produce excess hormones) or non-functional. Although most of these are benign adrenal tumors, their growth or alteration in hormone production can cause symptoms that affect the patient’s quality of life and necessitate surgery.

Some of the most common indications for endocrine surgery include:

• Adrenal tumors larger than 4 cm, as they have a higher risk of malignancy.
• Hormone-secreting tumors, which can cause hypertension, metabolic alterations, or mood changes.
• Metastasis from other cancers in the adrenal gland.
• Adrenal carcinoma, a rare but aggressive type of malignant tumor.

Symptoms of adrenal tumors

The symptoms of adrenal gland tumors depend on the type and hormonal impact. Some of the most common include:

• Resistant hypertension.
• Metabolic alterations, such as unexplained weight gain or loss.
• Chronic fatigue and muscle weakness.
• Excessive sweating, palpitations, and anxiety.
• Mood changes, insomnia, or irritability.
• Symptoms from excess cortisol or aldosterone, such as Cushing’s syndrome or hyperaldosteronism.

If you experience any of these symptoms, it is essential to undergo blood and urine tests, as well as imaging tests like CT or MRI, to confirm the diagnosis and determine the best treatment.

What to do once an adrenal tumor is discovered?

Once blood and urine tests, CT, or MRI are performed, the problem can be characterized, leading to a diagnosis of an adrenal tumor. With this information, specialists can determine the prognosis and the most appropriate treatment for each patient.

Adrenal gland surgery as the main treatment

More than 90% of tumors affecting the adrenal glands are benign. Despite this, medical protocols recommend surgery in the majority of these cases to avoid future complications.

“More than 90% of tumors affecting the adrenal glands are benign”

Dr. Oscar Vidal

Hormone-producing adrenal tumors

Any adrenal tumor with autonomous hormone production should be surgically removed, regardless of its size or location. With surgery, most cases are considered cured. However, if it is an adrenal carcinoma, long-term follow-up and, in some cases, additional treatments like chemotherapy are essential.

“Any adrenal tumor with autonomous hormone production should be surgically removed”

Dr. Oscar Vidal

Non-hormone-producing adrenal tumors

When an adrenal tumor does not produce hormones, strict monitoring is required. These tumors are monitored annually or biannually until they reach 4 cm. Once this size is reached, surgery is recommended to prevent malignancy, other possible adrenal tumor symptoms: compressive symptoms, internal bleeding, or spontaneous ruptures.

“An adrenal tumor that does not produce hormones is monitored annually or biannually until it reaches 4 cm and should be removed”

Dr. Oscar Vidal

Adrenal tumor surgery: advances in functional preservation

Traditionally, surgical treatment of adrenal gland tumors involved the complete removal of the affected organ. However, advances in minimally invasive surgery have allowed the development of functional preservation techniques, reducing the risk of adrenal insufficiency.

Why is adrenal function preservation important?

In some cases, such as bilateral surgeries or patients with a single functional gland, total removal leads to chronic adrenal insufficiency, requiring lifelong medication and potentially affecting the patient’s quality of life.

“Adrenal insufficiency is a true calamity for the patient and has been shown to significantly decrease their quality of life and that of their closest relatives.”

Dr. Oscar Vidal

Benefits of minimally invasive adrenal surgery with functional preservation

• Preserve part of the adrenal gland when possible.
• Reduce the risk of postoperative adrenal insufficiency.
• Decrease pain and hospitalization time.
• Avoid complications associated with open surgery.
• Reduce the use of replacement medication.
• Greater metabolic and hormonal stability.
• Less impact on blood pressure and mood.
• More favorable long-term prognosis.

“We have developed a minimally invasive approach that allows us to preserve adrenal function, reduce hospital stay, and minimize complications.”

Dr. Òscar Vidal

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