Our Summary

The research paper is about improving the surgical treatment of adrenal gland disorders, i.e., adrenalectomy. The researchers analyzed medical literature from 1980 to 2021 and identified seven areas of concern for surgeons.

Their findings include:

  • Patients with adrenal gland abnormalities that are 1cm or larger should undergo further testing and imaging.
  • CT scans can help determine the risk of cancer and other adrenal gland issues.
  • Routine follow-up for benign, non-functional adrenal nodules is not necessary.
  • When a disease affects only one adrenal gland, a laparoscopic adrenalectomy (a less invasive surgical procedure) is suggested for patients with certain adrenal conditions.
  • Patients showing signs of adrenal gland cancer should be treated at specialized medical centers to get the best outcomes, including complete removal of the tumor without disruption.
  • Certain types of medications can help prepare patients for surgery to remove adrenal gland tumors.
  • Hormone replacement therapy is necessary for patients with severe Cushing syndrome (a disorder caused by high levels of cortisol), but for patients with mild autonomous cortisol secretion, further testing can help determine if this therapy is needed.
  • Minimally invasive adrenalectomy is recommended over open adrenalectomy due to improved recovery times. This can be done either through the back (retroperitoneal) or the abdomen (transperitoneal) based on the surgeon’s expertise and patient’s characteristics.

The research provides 26 recommendations to help surgeons improve their treatment of adrenal gland disorders.

FAQs

  1. What are the findings of the research on improving surgical treatment of adrenal gland disorders?
  2. When is a laparoscopic adrenalectomy suggested according to the research?
  3. What is the recommendation for patients with severe Cushing syndrome?

Doctor’s Tip

One helpful tip a doctor might tell a patient about adrenalectomy is to make sure to follow the pre-operative and post-operative instructions provided by the surgical team. This may include avoiding certain medications, fasting before the surgery, and taking prescribed medications after the surgery to aid in recovery. By following these instructions carefully, the patient can help ensure a successful outcome and quicker recovery.

Suitable For

Patients who are typically recommended for adrenalectomy include those with adrenal gland abnormalities larger than 1cm, signs of adrenal gland cancer, certain adrenal conditions affecting only one gland, severe Cushing syndrome requiring hormone replacement therapy, and mild autonomous cortisol secretion requiring further testing. Additionally, patients who may benefit from minimally invasive adrenalectomy over open adrenalectomy are also recommended for surgery. It is important for patients with adrenal gland disorders to undergo proper testing and imaging to determine the best course of treatment and to receive care at specialized medical centers for optimal outcomes.

Timeline

Before adrenalectomy:

  • Patient presents with symptoms such as high blood pressure, weight gain, fatigue, and/or abdominal pain.
  • Initial evaluation includes physical examination, blood tests, and imaging studies such as CT scans.
  • Further testing is done if adrenal gland abnormalities are found, including adrenal hormone testing and biopsy if necessary.
  • Treatment options are discussed, and surgery may be recommended if the adrenal gland disorder is causing significant symptoms or is suspected to be cancerous.

After adrenalectomy:

  • Patient undergoes pre-operative preparation, which may include medication adjustments to control hormone levels.
  • Adrenalectomy is performed, either through laparoscopic surgery or open surgery depending on the specific condition and patient characteristics.
  • Post-operative care includes monitoring for complications such as bleeding, infection, or hormone imbalances.
  • Patients may require hormone replacement therapy if one or both adrenal glands are removed.
  • Follow-up appointments are scheduled to monitor recovery and ensure the successful resolution of symptoms.
  • In the long term, patients may need ongoing monitoring for potential recurrence of adrenal gland disorders or new hormone imbalances.

What to Ask Your Doctor

Some questions a patient could ask their doctor about adrenalectomy based on the research findings could include:

  1. Should I undergo further testing and imaging if my adrenal gland abnormality is 1cm or larger?
  2. How can CT scans help determine the risk of cancer and other adrenal gland issues?
  3. Do I need routine follow-up for a benign, non-functional adrenal nodule?
  4. Is laparoscopic adrenalectomy a suitable option for me if I have a disease affecting only one adrenal gland?
  5. Should I be treated at a specialized medical center if I show signs of adrenal gland cancer?
  6. Are there any medications that can help prepare me for surgery to remove my adrenal gland tumor?
  7. Will I need hormone replacement therapy if I have severe Cushing syndrome?
  8. Is minimally invasive adrenalectomy recommended for me over open adrenalectomy? If so, which approach (retroperitoneal or transperitoneal) would be best for my situation?

These questions can help patients understand their treatment options and make informed decisions about their care.

Reference

Authors: Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. Journal: JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622