Adrenalectomy
Keyhole surgery to remove an adrenal gland, the small hormone gland on top of the kidney, usually because of a tumor that makes too much hormone or could be cancer.
Also called adrenal gland removal, laparoscopic adrenalectomy, robotic adrenalectomy, posterior retroperitoneoscopic adrenalectomy, PRA, remove adrenal tumor, adrenal adenoma surgery, pheochromocytoma surgery
- Where
- Hospital operating room
- Anesthesia
- General anesthesia (you are fully asleep)
- Time in the room
- About 1 to 3 hours
- Hospital stay
- Usually 1 night; 1 to 3 nights for pheochromocytoma or open surgery
- Back to normal
- About 2 to 3 weeks
- Back to work
- Desk work in 1 to 2 weeks; physical work in about 4 to 6 weeks
Overview
You have two adrenal glands, one on top of each kidney. They are small, flat glands that make hormones: aldosterone, which controls salt, potassium and blood pressure; cortisol, the stress hormone that also affects blood sugar, weight and bones; and adrenaline, the fight-or-flight hormone. An adrenalectomy removes one adrenal gland. The other gland can do the job on its own.
Most adrenal lumps found on scans are harmless and make no extra hormone, so they need no surgery. Surgery is recommended when a tumor makes too much hormone, or when it is large, growing, or looks suspicious for cancer on the scan.
Most adrenalectomies are done through small keyhole cuts, either from the front of the belly with you lying on your side, or from the back with you lying face down. Open surgery is reserved mainly for large tumors that may be cancer. The operation is done by urologists, endocrine surgeons or general surgeons with adrenal experience.
The special part of this operation is the hormone preparation before and after. A pheochromocytoma, a tumor that makes adrenaline, needs 1 to 2 weeks of blood pressure medicine first to prevent dangerous spikes. After removing a cortisol-making tumor, you need cortisol pills for months while the other gland wakes up. After removing an aldosterone-making tumor, your potassium and blood pressure medicines usually change.
The parts of your body involved
The adrenal glands sit on top of the kidneys, high in the back of the belly, inside the same fat that surrounds each kidney. Each gland is about 2 inches (4 to 6 centimeters) long, thin, and shaped like a triangle or crescent. The outer layer, the cortex, makes aldosterone and cortisol. The inner core, the medulla, makes adrenaline. The right adrenal lies tucked behind the liver, with its short main vein draining straight into the vena cava, the body's largest vein. The left adrenal lies near the spleen and pancreas, and its vein drains into the left kidney vein.
- Adrenal cortex
The outer layer, which makes aldosterone and cortisol.
- Adrenal medulla
The inner core, which makes adrenaline. Pheochromocytomas start here.
- Adrenal vein
The gland's main vein. On the right it is short and enters the vena cava directly, so it is handled with great care.
- Kidney
Just below the gland. It is left in place.
- Vena cava
The body's largest vein, right next to the right adrenal.
Why it’s done
Your team recommends removing the gland to cure a hormone problem, to remove a tumor that might be cancer, or both.
- Too much aldosterone
An aldosterone-making tumor causes high blood pressure and often low potassium. Surgery is recommended when tests show the extra hormone comes from one side.
- Too much cortisol
A cortisol-making tumor can cause weight gain, diabetes, weak bones, high blood pressure, easy bruising and mood changes. Some milder cases also benefit from surgery.
- Pheochromocytoma
These tumors release bursts of adrenaline, causing pounding headaches, sweating, racing heart and dangerous blood pressure spikes. Surgery is the treatment.
- Size or growth
Larger tumors, often over about 4 centimeters, or tumors that grow on scans, have a higher chance of being cancer.
- Suspicious appearance
Tumors that look unlike a simple adenoma on CT or MRI may be removed to rule out cancer.
Other options
- Watching with scans and hormone tests
For small adrenal lumps that make no extra hormone and look harmless, no surgery is needed. Your team may repeat a scan or hormone tests.
- Medicines for aldosterone excess
Spironolactone or eplerenone block aldosterone's effects. They are lifelong and are the main treatment when both glands are overactive or surgery is not wanted.
- Medicines for cortisol excess
Several medicines can lower cortisol production when surgery is not possible or as a bridge to surgery.
- Partial (cortical-sparing) adrenalectomy
Removing only the tumor and keeping part of the gland, mainly for inherited conditions with tumors on both sides.
- Open adrenalectomy
Through a larger cut, for very large tumors or tumors likely to be adrenal cancer.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks to months before
1 to 2 weeks before: pheochromocytoma
1 to 2 weeks before: other tumors
The day before and morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and lying on your side
You fall fully asleep and a breathing tube is placed. You are turned onto your side, tumor side up. For pheochromocytoma, the anesthesia team places a thin line in an artery at the wrist to watch your blood pressure with every heartbeat.
More detail
In the posterior approach, you lie face down and the surgeon works from the back, never entering the belly cavity. It suits smaller tumors and people with past belly surgery. Both approaches have very good results.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Blood pressure watching
Your blood pressure is checked often. After pheochromocytoma removal it may run low for a day and need fluids, sometimes in an intensive care or step-down unit.
- Blood sugar checks
After pheochromocytoma removal, blood sugar can drop in the first day, so it is checked regularly.
- Hormone changes
After a cortisol tumor, you start cortisol replacement pills. After an aldosterone tumor, potassium pills and spironolactone are usually stopped, and potassium is checked.
- Pain control
Acetaminophen and other non-opioid medicines, with opioids if needed.
- Walking and eating
Walking the same evening or next morning and eating normally soon after.
- Going home
Most people go home after 1 night; a little longer after pheochromocytoma or open surgery.
At home
- Pain
Soreness at the cuts and shoulder-tip pain from gas for a few days. Use acetaminophen on a schedule.
- Steroid pills, if prescribed
Take them exactly as directed and never stop suddenly. The dose is lowered slowly over months as your other gland recovers.
- Sick-day rules
If you take steroid replacement and get a fever, vomiting or a bad illness, your dose may need to go up. Your team will give you written rules and may suggest a medical alert bracelet.
- Blood pressure
Check it at home and keep a log. Many people need fewer blood pressure medicines; your team will adjust them.
- Incisions
Shower after 24 to 48 hours; avoid baths and swimming for about 2 weeks.
- Activity and lifting
Walk daily. Avoid lifting more than about 10 to 15 pounds (5 to 7 kilograms) for about 4 weeks.
- Driving
Not while taking opioid pain medicine. Most people drive in about 1 week.
- Work
Desk work in 1 to 2 weeks; physical work in about 4 to 6 weeks.
Recovery timeline
- Day of surgerySurgery
You wake with close blood pressure monitoring.
- Day 1 to 2Home
Most people go home after 1 night.
- Week 1Pathology report
The report confirms the tumor type and whether there is any sign of cancer.
- Weeks 1 to 4Hormone and blood pressure checks
Potassium, blood pressure and medicine adjustments for aldosterone tumors; steroid dose plan for cortisol tumors.
- 2 to 6 weeksPost-surgery hormone tests
After pheochromocytoma, metanephrine levels are rechecked to confirm cure.
- About 3 to 6 monthsFull effect
Blood pressure changes after an aldosterone tumor usually show by now.
- 6 to 18 monthsSteroid taper
After a cortisol tumor, the other adrenal slowly recovers and steroid pills are tapered and stopped.
- Long termOngoing follow-up
Yearly tests for life after pheochromocytoma, and follow-up based on the tumor type for others.
What it feels like
The surgery itself is usually a short keyhole operation with a quick recovery. The hormone side, before and after, is what many people find most demanding.
Taking the alpha-blocker before pheochromocytoma surgery
Dizziness when standing, a stuffy nose and tiredness for a week or two.
What helpsStand up slowly, drink fluids, eat the extra salt your team advises, and report blood pressure readings as asked.
Waking up
Sore keyhole cuts, shoulder-tip pain from the gas, and many blood pressure checks.
What helpsWalk early; it eases the gas pain. Ask for pain medicine before pain builds.
After a cortisol tumor
As cortisol drops to normal, many people feel tired, achy, and low in mood for weeks, even on replacement pills.
What helpsThis is expected and means the tumor is gone. Do not stop your steroid pills. Tell your team if you feel very weak or nauseated.
After an aldosterone tumor
Relief at stopping potassium pills, and sometimes surprise at needing fewer blood pressure medicines.
What helpsKeep a blood pressure log and bring it to visits so medicines can be adjusted safely.
Waiting for the pathology report
Worry about whether it was cancer.
What helpsMost adrenal tumors removed are benign. Ask when the report will be ready and who will explain it.
How well it works
Success means the tumor is removed and the hormone problem is cured or clearly improved.
- Aldosterone tumors
Potassium returns to normal in nearly everyone. Blood pressure improves in most people, and about a third no longer need any blood pressure medicine.
- Cortisol tumors
Weight, blood sugar, blood pressure and skin changes improve over 6 to 12 months. Steroid pills are needed until the other gland recovers.
- Pheochromocytoma
Adrenaline-related symptoms usually stop. Metanephrine tests a few weeks later confirm cure, and yearly testing continues because new tumors can occur.
- Pathology
The report confirms the tumor type and whether there is any sign of cancer.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
For 1 to 2 weeks.
Fades in 1 to 3 days.
Common after surgery, especially for pheochromocytoma and aldosterone tumors.
Expected; treated with steroid pills for months.
Less common
May need fluids and close monitoring for a day.
Usually in the first day; treated with sugar through the IV.
The other gland can be slow to restart. Usually temporary.
Uncommon; rarely needs a transfusion.
Wound, urine or lung infection.
For bleeding, scar tissue or a tumor larger or more invasive than expected.
Rare
The vena cava, liver, spleen, pancreas, kidney or bowel can rarely be injured.
Dangerously low cortisol, with vomiting, weakness and low blood pressure. Prevented by taking steroid pills as directed.
Rare, more with the approach from the back.
More likely with high cortisol.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Severe weakness, dizziness or fainting, nausea or vomiting, especially if you take steroid pills (go to the emergency room and say you have adrenal insufficiency)
- Unable to keep down steroid pills because of vomiting
- Blood pressure much higher or lower than your usual, or a pounding headache with sweating
- Muscle weakness, cramps or a new irregular heartbeat (possible potassium problem)
- Pain, swelling or redness in one calf, or chest pain or trouble breathing (call 911)
- Redness spreading from a cut, pus, or a cut that opens
Questions to ask your surgeon
- Does my tumor make extra hormone, and which one?
- Has adrenal vein sampling shown it is one side?
- How likely is it that my tumor is cancer?
- Will you operate from the front or the back?
- How many adrenalectomies do you do each year?
- What medicine preparation do I need, and for how long?
- Will I need steroid pills afterward, and for how long?
- Which blood pressure medicines will I stop or change?
- Should I have genetic testing?
- What follow-up tests will I need?
Words you may hear
- Adrenal gland
- A small gland on top of each kidney that makes aldosterone, cortisol and adrenaline.
- Adrenalectomy
- Surgery to remove an adrenal gland.
- Aldosterone
- A hormone that controls salt, potassium and blood pressure.
- Primary aldosteronism (Conn syndrome)
- Too much aldosterone, often from a small benign adrenal tumor.
- Cortisol
- The main stress hormone, which affects blood sugar, weight, bones and blood pressure.
- Cushing syndrome
- Health problems caused by too much cortisol.
- Pheochromocytoma
- A tumor of the adrenal core that makes too much adrenaline.
- Metanephrines
- Breakdown products of adrenaline measured in blood or urine to detect pheochromocytoma.
- Alpha-blocker
- A blood pressure medicine that relaxes blood vessels, used before pheochromocytoma surgery.
- Adrenal vein sampling
- A test that takes blood from each adrenal vein to find which side makes too much aldosterone.
- Adrenal insufficiency
- Too little cortisol, which can cause weakness, nausea and low blood pressure.
- Adrenal incidentaloma
- An adrenal lump found by chance on a scan done for another reason.
Common questions
Can I live normally with one adrenal gland?
Yes. The remaining gland makes enough hormones for normal life. After a cortisol tumor, it may need months to wake up, which is why steroid pills are given meanwhile.
Will my blood pressure be cured?
After an aldosterone tumor, blood pressure improves in most people, and about a third stop all blood pressure medicines. Many others need fewer. Long-standing high blood pressure or other causes may keep some people on medicine.
Why do I need medicine for two weeks before pheochromocytoma surgery?
Handling the tumor can release large amounts of adrenaline and cause dangerous spikes in blood pressure. The alpha-blocker relaxes the blood vessels ahead of time to keep you safe.
Is my adrenal tumor cancer?
Most adrenal tumors are benign. Adrenal cancer is rare. Size, growth and scan features help estimate the risk, and the pathology report gives the answer.
Why not just biopsy it?
Adrenal biopsy is rarely helpful. It often cannot tell a benign tumor from cancer, and biopsy of a pheochromocytoma can trigger a dangerous adrenaline surge. Hormone tests and scans usually guide the decision instead.
Sources this page draws on
- Endocrine Society, Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline (2014)
- Endocrine Society, The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment (2016)
- Endocrine Society, Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline (2015)
- American Association of Endocrine Surgeons, Guidelines for Adrenalectomy (JAMA Surgery)
- European Society of Endocrinology and European Network for the Study of Adrenal Tumors, Clinical Practice Guideline on the Management of Adrenal Incidentalomas
- The Lancet Diabetes and Endocrinology, PASO study: outcomes after adrenalectomy for unilateral primary aldosteronism (Williams et al.) (2017)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.