Adrenal Tumor Surgery

Introduction

If you have been told you have an adrenal tumor and surgery is being discussed, you are likely sorting through a lot of new information at once. Many adrenal tumors are found by accident on a scan done for something else, while others come to light because of high blood pressure, hormone changes, or symptoms that have been hard to explain. The good news is that most adrenal tumors that come to surgery are benign (non-cancerous), and modern minimally invasive techniques mean that recovery is usually faster and more comfortable than it was a generation ago.

This guide explains what adrenal tumor surgery, also called adrenalectomy, involves. It covers why the operation is done, the different surgical approaches your team may consider, how preparation differs depending on the type of tumor, what to expect during and after surgery, and what life looks like once you have recovered. The aim is to give you a clear picture so that your conversations with your surgeon and endocrinologist feel less daunting.

What Is Adrenal Tumor Surgery?

Adrenal tumor surgery is the operation to remove a tumor from one of the adrenal glands. The medical term is adrenalectomy, which simply means “removal of the adrenal gland.” In most cases, the entire affected gland is removed along with the tumor inside it, because the gland is small and the tumor and gland tissue are usually closely intertwined. In some carefully selected situations, only part of the gland is removed; this is called a partial or cortical-sparing adrenalectomy.

You have two adrenal glands, one sitting on top of each kidney. Each gland is small — roughly the size of a walnut — but they produce hormones that are essential to life. The outer layer (the cortex) produces cortisol, aldosterone, and small amounts of sex hormones. The inner core (the medulla) produces adrenaline and related hormones. When a tumor develops in either part of the gland, it may overproduce one of these hormones, or it may simply grow without causing any hormone problem at all. Surgery is considered when the tumor is overproducing a hormone, when it is large or growing, when imaging suggests it could be cancerous, or when it is causing physical symptoms.

Removing one adrenal gland is generally well tolerated because the gland on the other side continues to function and can usually produce enough hormones for the body’s needs. Removal of both glands — bilateral adrenalectomy — is rare and requires lifelong hormone replacement.

Why Is Adrenal Tumor Surgery Performed?

Adrenal surgery is not done for every adrenal lump that turns up on a scan. In fact, most small, non-hormone-producing adrenal nodules are simply watched over time. Surgery is generally considered in the following situations.

Hormone-producing tumors

Tumors that secrete excess hormones often cause significant illness and tend to do best with surgical removal. The main types include:

• Cortisol-producing adenomas, which cause Cushing’s syndrome — weight gain in the trunk and face, easy bruising, thin skin, high blood sugar, mood changes, and muscle weakness.
• Aldosterone-producing adenomas (Conn’s syndrome), which cause hard-to-control high blood pressure and low potassium levels.
• Pheochromocytomas, which arise from the medulla and release adrenaline-type hormones in surges. They can cause spells of severe high blood pressure, headache, sweating, palpitations, and anxiety. The Endocrine Society recommends surgical removal of essentially all pheochromocytomas, with careful medical preparation beforehand.
• Sex hormone-producing tumors, which are uncommon but can cause early puberty in children, virilisation in women, or feminising changes in men.

Tumors that are large, growing, or suspicious for cancer

Even when a tumor is not making excess hormones, surgery is often recommended if it is above a certain size, if it has features on imaging that raise concern for cancer, or if follow-up scans show that it is growing. International guidance, including from the American Association of Endocrine Surgeons (AAES) and the European Society of Endocrinology, generally suggests that non-functioning adrenal tumors larger than about 4 cm are considered for removal, because the risk that the tumor is an adrenocortical carcinoma rises with size. Smaller tumors with worrying features on CT or MRI — such as irregular borders, high density, or slow washout of contrast — may also be considered for surgery.

Symptomatic tumors

Larger tumors can sometimes press on neighbouring structures, causing dull pain in the side or back, or a sense of fullness. Surgery can relieve these symptoms.

Adrenal metastases (selected cases)

Occasionally, cancer from elsewhere in the body (for example, lung or kidney cancer) spreads to the adrenal gland. In some carefully chosen patients, removing an isolated adrenal metastasis can be part of the cancer treatment plan, decided together with the oncology team.

Who Is a Candidate for Adrenal Tumor Surgery?

Candidacy depends on several factors that your surgeon and endocrinologist will weigh together.

• The type of tumor. Hormone-secreting tumors, suspicious or larger tumors, and pheochromocytomas are the main groups that come to surgery.
• Tumor size and location. Small to moderate tumors are typically suitable for minimally invasive surgery. Very large tumors, or those that appear to invade nearby structures, may need an open operation.
• Overall fitness for surgery. General anaesthesia and abdominal surgery require reasonable heart, lung, and kidney function. Conditions like uncontrolled diabetes, severe heart disease, or active infection may need to be optimised first.
• Hormonal control before surgery. This is especially important for pheochromocytomas (to control blood pressure surges) and cortisol-producing tumors (to plan steroid coverage). Operating on an unprepared pheochromocytoma can be dangerous, so preoperative medical preparation is a non-negotiable step.
• Patient preferences and the broader picture. For some patients with small, non-functioning, low-risk tumors, active surveillance with repeat imaging and hormone testing is an entirely reasonable alternative to surgery.

Whether surgery is the right next step is a clinical decision made together with you, your endocrinologist, and your surgeon. A multidisciplinary discussion is particularly valuable for hormone-secreting tumors, suspected cancers, and very large or complex tumors.

Alternatives to Surgery

Surgery is the definitive treatment for most hormone-producing and suspicious adrenal tumors, but it is not the only option in every situation. Major societies recommend that alternatives be discussed where appropriate.

Active surveillance (watching)

For small, non-hormone-producing tumors that look benign on imaging, current guidelines often support a watch-and-wait approach. This typically means repeat scans at intervals (for example, after 6–12 months and again later) and repeat hormone testing. If the tumor remains stable and silent, surgery may never be needed.

Medical management

Medications cannot remove an adrenal tumor, but they can sometimes control the effects of excess hormones. Examples include:

• Aldosterone antagonists (such as spironolactone or eplerenone) for primary aldosteronism, particularly in patients who are not surgical candidates or who have aldosterone excess from both glands rather than a single tumor.
• Cortisol-blocking medications (such as metyrapone, ketoconazole, or osilodrostat) for Cushing’s syndrome, often as a bridge before surgery or when surgery is not possible.
• Alpha and beta blockers for pheochromocytoma — but here, medication is almost always used to prepare for surgery rather than as a long-term substitute for it.

Other procedures

In selected cases, image-guided techniques such as radiofrequency ablation or microwave ablation may be considered for small adrenal metastases in patients who cannot undergo surgery. These are specialised approaches and are not a routine alternative to adrenalectomy for primary adrenal tumors.

Whether any of these alternatives apply to a particular patient depends on the tumor type, the level of hormone excess, and the overall clinical picture.

Surgical Approaches

There are several ways to perform an adrenalectomy. The choice depends on the tumor size, suspected nature, location, the patient’s body shape and prior surgeries, and the surgeon’s experience. Most adrenal operations today are minimally invasive.

Laparoscopic transabdominal adrenalectomy

This is the most common minimally invasive approach. The surgeon makes three or four small incisions in the front or side of the abdomen, inflates the abdomen with carbon dioxide gas to create working space, and uses a camera and long, thin instruments to remove the gland. The patient is usually positioned on their side. This approach gives a wide view of the abdomen, which can be helpful when the tumor is larger or when other structures need to be inspected.

Posterior retroperitoneoscopic adrenalectomy

In this approach, the surgeon reaches the adrenal gland from the back, with the patient lying face down. Small incisions are made just below the ribs at the back. Because the surgeon does not enter the abdominal cavity, recovery may be quicker for some patients, and it can be particularly useful when both adrenal glands need to be operated on in the same session or when the patient has had previous abdominal surgery. It works best for smaller tumors and requires specific training and experience.

Robotic adrenalectomy

Robotic surgery uses the same minimally invasive principles as laparoscopy but with robotic arms controlled by the surgeon from a console. The wristed instruments and three-dimensional view can give the surgeon more precision in tight spaces. Outcomes are broadly similar to laparoscopic surgery in experienced hands, and the choice between robotic and laparoscopic often depends on local availability and surgical preference.

Open adrenalectomy

An open operation involves a single larger incision, usually in the upper abdomen or in the side just below the ribs. It is typically reserved for very large tumors (often above 6–8 cm, though thresholds vary), tumors with features suggesting cancer, suspected adrenocortical carcinoma, or situations where a minimally invasive approach is not safe. AAES guidance favours an open approach when there is a strong suspicion of adrenocortical carcinoma, because the principles of cancer surgery — removing the tumor in one piece with surrounding tissue if needed — are easier to achieve through an open incision. Recovery is longer than after minimally invasive surgery, but the trade-off is the safer removal of a potentially malignant tumor.

Partial (cortical-sparing) adrenalectomy

For certain patients — particularly those with tumors in both glands due to a genetic syndrome — the surgeon may try to remove only the tumor itself and leave behind some healthy adrenal cortex. The aim is to preserve enough hormone production to avoid lifelong steroid replacement. This is technically demanding and is offered only in specific situations.

Preparing for Adrenal Tumor Surgery

Preparation for adrenalectomy is more involved than for many other operations, because the gland produces hormones that affect the heart, blood pressure, and metabolism. Careful preparation makes the surgery much safer.

Confirming the diagnosis

Before surgery is scheduled, your team will usually want clear answers to three questions: where the tumor is, whether it is producing excess hormones, and whether it has any features suggesting cancer. This typically involves CT or MRI of the adrenal area, blood and urine tests for cortisol, aldosterone (with a paired renin level), and metanephrines (markers of pheochromocytoma), and sometimes specialised tests such as a dexamethasone suppression test, adrenal vein sampling (for aldosterone-producing tumors), or functional imaging.

Hormonal preparation

• Pheochromocytoma: Patients are typically started on an alpha blocker (such as phenoxybenzamine or doxazosin) for around 1–3 weeks before surgery, with a beta blocker added later if needed. Salt and fluid intake is often increased in the days before surgery to expand blood volume. This preparation reduces the risk of dangerous blood pressure swings during the operation. The Endocrine Society guideline for pheochromocytoma and paraganglioma considers this preoperative blockade essential.
• Cortisol-producing tumor (Cushing’s syndrome): Because the unaffected adrenal gland may have become “lazy” from years of high cortisol, you will need steroid coverage around the time of surgery and often for weeks or months afterwards as the remaining gland recovers.
• Aldosterone-producing tumor: Blood pressure and potassium levels are optimised. Some medications (such as spironolactone) may be paused or adjusted before specific tests and surgery.
• Non-functioning tumor: Less hormonal preparation is needed, but routine surgical workup still applies.

General preoperative steps

• Blood tests, ECG, and an anaesthesia review.
• Review of all current medications. Blood thinners, some diabetes medications, and certain blood pressure drugs may need to be adjusted or paused.
• Instructions on fasting — usually no food for several hours before surgery.
• Stopping smoking, if applicable, even for a few weeks before surgery improves wound healing and reduces lung complications.
• Arranging help at home for the first week or two of recovery.

Your surgical team will walk you through these steps individually, and the exact preparation depends on the tumor type and your overall health.

What Happens During Adrenal Tumor Surgery

On the day of surgery, you will be admitted to hospital, change into a gown, and meet the anaesthesia and surgical teams. An intravenous line is placed, and you may have additional monitoring lines, especially if you have a pheochromocytoma, where close blood pressure monitoring during the operation is important.

1. You are positioned on the operating table — on your side for most laparoscopic operations, on your front for the posterior approach, or on your back or side for an open operation.
2. The skin is cleaned, and either small incisions (for minimally invasive surgery) or a single larger incision (for open surgery) is made.
3. For minimally invasive surgery, gas is used to create working space and a camera is introduced. For open surgery, the surgeon works directly through the incision.
4. The surgeon carefully identifies and protects nearby structures — the kidney, the major blood vessels (the inferior vena cava on the right, the aorta on the left), the spleen and pancreas on the left, and the liver on the right.
5. The blood supply to the adrenal gland is identified and divided, and the gland (with the tumor) is gently freed from surrounding tissue.
6. The specimen is placed in a retrieval bag and removed through one of the incisions, sometimes after being extended slightly.
7. The surgeon checks for bleeding, washes out the area, and closes the incisions.

The operation usually takes around 2–3 hours, though larger or more complex tumors can take longer. The removed gland is sent for laboratory analysis (pathology) to confirm the tumor type. Final pathology results typically take several days to a week or more.

Recovery and Healing

Recovery from adrenalectomy is generally smoother after a minimally invasive operation than after open surgery, but the broad pattern is similar.

In hospital

After minimally invasive adrenalectomy, most patients stay in hospital for 2–3 days. After open surgery, the stay is typically longer — often 4–7 days. During the hospital stay, the team will:

• Monitor blood pressure, heart rate, and oxygen levels closely — especially in the first 24 hours, and particularly after pheochromocytoma surgery, when blood pressure can swing.
• Manage pain with a combination of medications.
• Encourage you to get out of bed and walk on the first day after surgery if possible. Early movement reduces the risk of blood clots and helps the bowel recover.
• Restart fluids and then food gradually.
• Check hormone levels and adjust medications as needed — for example, starting or continuing steroids after removal of a cortisol-producing tumor.

At home in the first weeks

Once home, you will continue to recover gradually. General expectations include:

• Wound care: Keep the incisions clean and dry as instructed. Watch for signs of infection — increasing redness, warmth, swelling, or discharge.
• Activity: Light walking is encouraged from the start. Avoid heavy lifting (anything more than around 5–7 kg) and strenuous activity for about 4–6 weeks, longer after open surgery.
• Driving: Usually possible once you are off strong pain medication and can move comfortably — often around 1–2 weeks after laparoscopic surgery, longer after open surgery.
• Work: Desk-based work is often possible after 2–3 weeks following minimally invasive surgery; physically demanding work usually requires longer.
• Pain: Mild to moderate pain at the incision sites and shoulder tip pain (from the gas used in laparoscopy) is common in the first few days and settles quickly.

Hormonal recovery

The hormonal side of recovery depends entirely on which tumor was removed.

• After surgery for a cortisol-producing tumor, the remaining adrenal gland is often suppressed and takes time to wake up. Patients usually need steroid replacement (such as hydrocortisone) for several months, sometimes longer. The dose is gradually tapered under endocrinology supervision. Stopping steroids suddenly during this recovery period can be dangerous.
• After surgery for an aldosterone-producing tumor, blood pressure often improves significantly, sometimes dramatically. Many patients are able to reduce or stop several blood pressure medications. Potassium levels usually normalise.
• After surgery for a pheochromocytoma, the immediate post-operative period needs careful blood pressure and blood sugar monitoring. Most patients see symptoms resolve quickly.
• After removal of a non-functioning tumor, no specific hormone replacement is needed; the remaining adrenal gland carries on as before.

Risks and Complications

Adrenalectomy in experienced hands is generally safe, but like any major operation, it carries risks. Understanding them helps you make informed decisions and recognise problems early.

General surgical risks

• Bleeding, which is uncommon but possible because the adrenal glands sit very close to major blood vessels.
• Infection of the wound or, less commonly, deeper infection.
• Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), reduced by early walking and, in selected cases, blood thinning medications.
• Reactions to anaesthesia.
• Hernia at the incision site, particularly after open surgery.

Specific risks of adrenal surgery

• Injury to nearby organs: The kidney, spleen, pancreas, liver, or large blood vessels can occasionally be injured. Surgeons take great care to avoid this, but the proximity of these structures is part of why adrenal surgery is best done in experienced centres.
• Conversion from minimally invasive to open surgery: Sometimes, what was planned as a laparoscopic operation needs to be converted to an open operation for safety reasons — for example, if bleeding is difficult to control or the tumor is more adherent than expected. This is not a complication in itself, but it does change the recovery.
• Blood pressure swings during pheochromocytoma surgery: Even with preparation, brief surges or drops in blood pressure can occur. Anaesthesia and surgical teams are prepared for this.
• Adrenal insufficiency: After removal of a cortisol-producing tumor (or both adrenal glands), the body cannot produce enough cortisol on its own. Patients need steroid replacement and education about “stress dosing” during illness. Failure to take stress doses during a major illness or injury can lead to an adrenal crisis, which is a medical emergency.
• Recurrence: Benign tumors rarely recur after complete removal. Pheochromocytomas have a small risk of recurrence over many years, particularly in patients with genetic predispositions, so long-term follow-up is recommended.

Overall, mortality from elective adrenalectomy in experienced centres is very low. Risks are higher with very large tumors, suspected cancer, emergency operations, and significant other illnesses.

Life After Adrenal Tumor Surgery

For most patients, life after adrenalectomy is a story of symptoms improving and gradually getting back to normal. The specifics depend on the reason for surgery.

After a cortisol-producing tumor

Many of the changes of Cushing’s syndrome — weight gain, skin changes, muscle weakness, mood disturbance — improve over months as cortisol levels normalise. Some changes, such as bone thinning, can take longer to reverse. Steroid replacement is gradually tapered under endocrinology supervision. You will be advised about wearing a medical alert and about taking extra steroid doses if you become significantly unwell, vomit, or face major stress like surgery or accidents, until your remaining gland fully recovers.

After an aldosterone-producing tumor

Blood pressure often improves significantly. Many patients are able to come off some or all of their blood pressure medications under their doctor’s guidance, though those who had high blood pressure for many years may still need some treatment.

After a pheochromocytoma

Spells of palpitations, sweating, and headache usually resolve. Long-term follow-up with periodic blood or urine tests for metanephrines is recommended, particularly in patients with genetic causes, because the tumor can recur or appear elsewhere over time.

After a non-functioning tumor

If the tumor was benign on final pathology, often no further specific follow-up is needed beyond standard post-operative checks. If it turned out to be malignant, an oncology-led follow-up plan is put in place.

Lifestyle

There is no specific “adrenal diet” after surgery. General healthy eating, regular activity once you have healed, good sleep, and not smoking all support recovery. If you had high blood pressure or diabetes related to a hormone-producing tumor, ongoing review of these conditions is important even as they improve.

Adrenal Tumor Surgery in Children

Adrenal tumors in children are uncommon, and when they do occur the picture is different from adults. The most common adrenal tumors in young children are neuroblastoma (a malignant tumor arising from neural crest cells) and, less often, pheochromocytoma, which in children is more frequently linked to genetic syndromes such as von Hippel–Lindau disease, multiple endocrine neoplasia type 2, or neurofibromatosis type 1. Cortisol- or aldosterone-producing adenomas are rare in childhood.

Because of this different mix of conditions, paediatric adrenal surgery is usually carried out by paediatric surgeons or paediatric urologists working closely with paediatric endocrinologists and oncologists. Children with suspected pheochromocytoma need careful preoperative blood pressure control just like adults. Genetic testing and counselling are an important part of the plan when an inherited syndrome is suspected, because it affects screening for other family members and long-term follow-up for the child.

Recovery in children is often quicker than in adults, but follow-up is typically longer because of the higher chance of an underlying genetic cause and the need to monitor growth and development.

Frequently Asked Questions

Will I be able to live a normal life with only one adrenal gland?

Yes, in most cases. One healthy adrenal gland can usually produce enough hormones for the body’s normal needs. The exception is when the remaining gland has been suppressed (for example, after long-standing Cushing’s syndrome) — in that situation, temporary or longer-term steroid replacement is needed until it recovers.

How is the choice made between laparoscopic, robotic, and open surgery?

The choice depends on the size and nature of the tumor, how suspicious it is for cancer, your prior surgical history and anatomy, and the surgeon’s experience. Minimally invasive surgery (laparoscopic or robotic) is favoured for most benign tumors. Open surgery is generally preferred when there is strong suspicion of adrenocortical carcinoma or when the tumor is very large. Your surgeon will discuss the rationale in your specific case.

Is adrenal surgery painful?

Some discomfort is expected after any operation. After minimally invasive surgery, pain is usually mild to moderate and well controlled with oral pain medications within a few days. Shoulder tip pain from the gas used in laparoscopy is common in the first 24–48 hours and settles quickly. Open surgery is associated with more pain and a longer period of recovery.

Will my high blood pressure go away after surgery?

It depends on the cause. Blood pressure related to an aldosterone-producing tumor or a pheochromocytoma often improves significantly — sometimes dramatically — after surgery. However, if you have had high blood pressure for many years, blood vessels may have changed over time, and some patients still need medication afterwards, though usually less than before.

How long does it take to know whether the tumor was benign or cancerous?

The removed tissue is examined under the microscope by a pathologist. Preliminary results may be available within a few days; final, detailed pathology often takes a week or more. Your surgeon will share these results with you and explain what they mean for follow-up.

Will I need lifelong medication after surgery?

Most patients having one adrenal gland removed do not need lifelong hormone medication. The main exceptions are patients who had a cortisol-producing tumor (who often need steroid replacement during the recovery period and sometimes for longer), patients who have had both glands removed (who need lifelong steroid and mineralocorticoid replacement), and selected patients whose remaining gland does not recover fully.

Can the tumor come back?

Most benign adrenal tumors do not return after complete removal. Pheochromocytomas have a small long-term risk of recurrence, particularly when there is a genetic background, which is why long-term follow-up is recommended. Adrenocortical carcinoma has a meaningful risk of recurrence and requires ongoing oncology follow-up.

How do I choose a surgeon for adrenal tumor surgery?

Adrenal surgery is best done by surgeons with specific experience — often endocrine surgeons, urologists, or general surgeons with a focus on adrenal and endocrine work. Useful things to look for include experience with the type of tumor you have, regular involvement in adrenal cases, working as part of a multidisciplinary team with an endocrinologist and anaesthetist familiar with adrenal disease, and clear communication with you about the plan. Meeting more than one surgeon before deciding is reasonable, especially for complex cases.

Conclusion

Adrenal tumor surgery is a well-established, generally safe operation that can resolve the symptoms of hormone-producing tumors, remove tumors that are large or suspicious, and restore quality of life for many patients. Modern minimally invasive techniques mean that for most benign tumors, the operation is done through small incisions and recovery measured in weeks rather than months. Careful preoperative preparation — especially hormonal preparation for pheochromocytomas and steroid coverage planning for cortisol-producing tumors — is what makes the surgery as safe as it is today.

If you have been diagnosed with an adrenal tumor, the path forward usually starts with a clear understanding of the tumor type, its hormonal activity, and its appearance on imaging. From there, your endocrinologist and surgeon can help you weigh surgery, surveillance, or medical management in the context of your individual situation. With the right preparation, the right approach, and an experienced team, most patients recover well and return to their lives with their symptoms resolved and their hormonal balance restored.