Adrenal

The adrenal glands are a pair of glands situated above the kidneys. Their chief role is the production of specific hormones, which allow the body to respond to stress, regulate the amount of salt and water in the body, as well as the development of adult bodily characteristics such as hair growth and body shape.

Adrenal nodules occur in 5% of the population. Within this group, most cases are non-cancerous and do not secrete any hormones.

The adrenal gland may need to be removed if:

• The tumour is found to make excess hormones
• Is large in size (more than 4-5 cm)
• If the tumour could be malignant (cancerous)

• Fever
• Weight loss
• Abdominal pain or sensation of fullness

• Weight gain
• Disturbances in menstrual cycle
• Generalised weakness
• Increased facial hair and acne
• Disturbances in the blood sugar level

• Increased urination and thirst
• High blood pressure
• Fatigue, muscle weakness, cramping and headaches

• High blood pressure
• Headaches
• Sensation that your heart is pounding

Test and diagnosis

Adrenal nodules can be evaluated either by a Computed Tomography scan or a Magnetic Resonance Imaging scan. Subsequently, depending on the patient's presentations and scan findings, blood and urine tests may be taken over 24 hours to test for excess amounts of adrenal hormones. Other laboratory studies may be obtained depending on individual patient findings.

If there is evidence of excessive hormone secretion, further evaluation may be required to assess the type of hormone being produced and the source of the excess hormone production.

Treatment

The treatment of adrenal nodules requires a multidisciplinary approach from different specialty services including the endocrinologist, radiologist and an experienced endocrine surgeon. Malignancy requires surgical intervention whenever possible. Other indications for the removal of the adrenal gland include excessive hormone secretion or a large tumour (more than 4cm in size).

Surgery can be done either via an open method (through a larger incision along the rib cage or the middle of the abdomen) or laparoscopically (three or four tiny incisions each about 1cm in length.) The choice of method depends on a number of factors, which include the size and type of the tumour.

Risks

Any operation involves some risk of:

• Blood clots in the legs (which can travel to the lungs)
  
• Lung problems
  
• Damage to other nearby organs (spleen and pancreas
  
• Heart attack or stroke
  
• Infection (5% of cases)
  
• Loss of bowel function
  
• Bleeding-Pain
• Allergic reaction
  
• Incomplete wound healing
  
• Scarring
  

The mortality rate of a laparoscopic adrenalectomy is about 0.3%, compared to an open adrenalectomy which has a mortality rate of 0.9% of cases.

• Associate Professor Ngiam Kee Yuan
• Assistant Professor Rajeev Parameswaran
• Associate Professor Cheah Wei Keat
• Dr James Lee