Adrenalectomy

An adrenalectomy removes more than a mass. It removes a source of cortisol, aldosterone, or catecholamines, and the patient’s postoperative physiology changes abruptly when that source disappears. The operation may be performed for a cortisol-secreting adenoma, aldosterone-producing adenoma, pheochromocytoma, or a lesion concerning for adrenocortical carcinoma. Minimally invasive adrenalectomy is preferred when tumour and patient characteristics permit because it reduces perioperative morbidity. Open surgery is more likely when the mass is large, locally invasive, or suspicious for malignancy. The experienced nurse asks one question before interpreting a postoperative blood pressure or glucose value: What was this tumour producing? - A catecholamine-secreting tumour can produce extreme hypertension during manipulation, then profound hypotension and hypoglycemia after removal. - A cortisol-secreting tumour may leave the patient unable to mount an adequate stress-cortisol response after surgery. - An aldosterone-producing tumour often presents with hypertension and hypokalemia before surgery, but transient hypoaldosteronism after surgery can cause hyperkalemia. A nonfunctioning benign-appearing adrenal lesion is different from a functional tumour. A homogeneous mass measuring 10 Hounsfield units or less on non-contrast CT is considered benign and does...