The adrenal glands are a pair of small, triangular-shaped glands located in the abdomen. One gland sits on the top of each kidney. The outer section of the gland is called the adrenal cortex. The inner part is the adrenal medulla.

The adrenal glands make hormones needed by the body. The adrenal cortex produces cortisol (a hormone used to help the body handle stress and help the body metabolize glucose, protein and fats), aldosterone (to regulate salt levels and blood pressure) and a small amount of sex hormones (androgens in men and estrogens in women). The adrenal medulla produces the stress hormones, norepinephrine and epinephrine.

Adrenal Tumors

Most tumors that affect the adrenal gland are small and benign. They usually don't cause any obvious symptoms and may only be found during a CT or MRI screening for another, unrelated problem.

In some cases, an adrenal tumor can cause excess production of hormones. Patients may experience severe headaches, anxiety, palpitations, sweating, and a rapid heart rate. Overproduction of cortisol can lead to the development of Cushing's syndrome, a condition characterized by obesity, high blood pressure, high glucose levels, menstrual problems, fragile skin and stretch marks. Excess production of aldosterone can cause high blood pressure and low potassium levels.

In rare cases, an adrenal tumor is a malignant growth. The American Cancer Society estimates only about 300 to 500 cases of adrenal cancer occur every year in the U.S. It's most common in adults 45 to 50. Women are affected more often than men.

Adrenalectomy

An adrenalectomy is the surgical removal of the adrenal gland. In the past, doctors would make a 6 to 12 inch incision into the abdomen or side to access and remove the gland. An alternative method of surgery is laparoscopy (called a laparoscopic adrenalectomy). Surgeons make three to four small incisions. Then, tiny surgical instruments are used to move aside internal organs and cut out all or a part of the affected gland.

Laparoscopic adrenalectomy is currently the preferred method of surgery for benign adrenal tumors. The smaller incisions mean less blood loss during surgery, less pain and a faster recovery. Most patients are able to leave the hospital in one to two days.

A "Backward" Approach

Terry C. Lairmore, M.D., a Surgical Oncologist with Scott and White in Temple, TX, says that although laparoscopic adrenalectomy is very popular, there is one drawback. The adrenal glands are located closer to the back, rather than the front of the body. Therefore, during laparoscopy, the surgeon must move vital organs to the side to get at the affected gland.

Lairmore is using a different approach to laparoscopic adrenalectomy. Instead of making the incisions in the abdomen or side, he makes them in the back. Only three small incisions are needed. Surgeons have direct access to the adrenal glands and don't need to push aside any of the vital organs. Lairmore says even the time needed for the operation is reduced.

The back approach for laparoscopic adrenalectomy isn't for everyone. Patients with larger tumors or those who are obese may require the traditional laparoscopic approach, or even open surgery.

For general information on adrenal tumors:

American Cancer Society

National Cancer Institute

General information about laparoscopic adrenalectomy is available from the Society of American Gastrointestinal and Endoscopic Surgeons at ttp://www.sages.org.