What Is an Adrenalectomy?

You have two adrenal glands, and each one sits like a small cap on top of a kidney. They are hormone factories: they make cortisol, aldosterone, and adrenaline-type hormones that help control blood pressure, salt and water balance, and the body's response to stress. An adrenalectomy is the operation to remove one of those glands — occasionally both — when the gland itself has become the problem. The clearest way to understand it is to follow it in order, step by step.

Step one: pinning down what the gland is doing

Surgery is rarely the first move. First, the team has to establish two things: what the gland is producing, and what it looks like. Blood and urine tests check hormone levels, because some adrenal growths overproduce a hormone — cortisol in Cushing syndrome, aldosterone, or adrenaline-type hormones in a growth called a phaeochromocytoma — while others produce nothing extra and are found by chance on a scan done for something else. Scans, usually CT or MRI, then show the size and position of the growth and help the surgeon plan. Size, hormone activity, and how the growth looks on imaging together drive the decision, which is why two people with an adrenal growth can be offered quite different plans. When a growth is cancerous or suspicious for cancer, that wider picture matters too; our cancer hub explains how cancer care is organised more generally.

Step two: getting the hormones under control first

If the gland is overproducing, that has to be settled before anyone operates. A gland that releases adrenaline-type hormones, for example, can push blood pressure sharply up when it is handled during surgery, so the team prepares for that in advance with medicines and fluids and plans the anaesthetic around it. Cortisol overproduction brings its own preparation, around blood pressure, blood sugar, and infection risk. This step is mostly invisible to the patient — blood tests, prescriptions, and planning meetings — but it is a big part of why the operation itself usually runs smoothly.

Step three: the operation — position, ports, and a camera

Most adrenalectomies today are done laparoscopically, as keyhole surgery, and the video at the top of this page follows exactly that approach: "Laparoscopic Left Adrenalectomy", running about three minutes, shows a left-sided keyhole removal in a case its description identifies as a patient with Cushing's. You will be asleep under a general anaesthetic, usually lying on your side so the surgeon can reach the gland from the front or the side of the abdomen. Several small cuts are made for a camera and slender instruments, the abdomen is gently inflated with gas to create working space, and the surgeon operates while watching the magnified view on a screen.

Step four: freeing the gland and sealing its vein

This is the careful part. The adrenal gland sits close to major structures — the large vein returning blood to the heart on the right side, the kidney just below, and other organs nearby — so the surgeon works the gland free gradually, keeping those structures in view. The gland's main vein is sealed and divided, which matters doubly for a hormone-producing gland, because handling it can release hormone into the circulation; the anaesthetist watches and manages blood pressure throughout. The gland is then placed in a small retrieval bag and brought out through one of the port sites, so it can be examined in the laboratory afterwards, as removed tissue routinely is. The companion video on this site, "Laparoscopic Right Adrenalectomy", follows the mirror-image operation on the right side, in a case described as involving a phaeochromocytoma.

Not every gland can, or should, come out by keyhole. A very large growth, one that looks invasive on scans, or one where cancer is strongly suspected may be removed through a larger open incision instead, because that gives the surgeon direct access and reduces the risk of disturbing the growth. Your surgeon should explain which route is planned for you, and why, before the day.

Step five: waking up, and watching the hormones settle

Afterwards you will wake up with the small port sites covered, and the team will watch your blood pressure and general recovery closely at first — especially if the gland was overproducing, because hormone levels can swing as the body adjusts to it being gone. Most people are up and moving, eating, and drinking far sooner than they expected, and tiredness is usually the main complaint in the first days rather than severe pain. If both glands were removed, or if the remaining gland needs time to take over, you may be given hormone replacement and clear instructions about it; that is planned, not a complication, and it will be explained before you go home. Blood tests at follow-up check that hormone levels and blood pressure are settling as expected.

Put the steps together and the shape of the operation makes sense: find out what the gland is doing, quiet it down if it is overactive, remove it — usually by keyhole — with its vein controlled, and then monitor while the body's hormone balance re-settles around the one gland that remains. For a neighbouring endocrine operation with a very different target, see our article on parathyroid surgery.

References & further reading

• MedlinePlus Medical Encyclopedia — Adrenal gland removal (adrenalectomy): https://medlineplus.gov/ency/article/007437.htm
• MedlinePlus — Adrenal Gland Disorders: https://medlineplus.gov/adrenalglanddisorders.html
• MedlinePlus — Cushing's Syndrome: https://medlineplus.gov/cushingssyndrome.html
• NHS — Phaeochromocytoma: https://www.nhs.uk/conditions/phaeochromocytoma/

Frequently Asked Questions

Can you live with only one adrenal gland?

Yes, in most cases. One healthy adrenal gland can usually make enough of the essential hormones for everyday life, which is why removing one gland is a well-established operation. If both glands are removed, hormone replacement is needed long term, and your team will arrange and explain that.

Is adrenalectomy always keyhole surgery?

No. Keyhole (laparoscopic) surgery is the usual route for smaller, non-cancerous growths, but a large growth, one that appears to be spreading into nearby tissue, or one where cancer is strongly suspected may be removed through an open incision instead. The choice depends on your scans and your surgeon's judgement.

Will my blood pressure improve after the gland is removed?

It can, when high blood pressure was being driven by the gland's excess hormone — for example aldosterone or adrenaline-type hormones. It does not help blood pressure that has other causes, and improvement is not guaranteed for any individual, which is why the hormone work-up in step one matters so much.

What are the main risks of this operation?

Alongside the general risks of anaesthesia, bleeding, and infection, the specific concerns are injury to nearby organs or major blood vessels, blood pressure swings during surgery when a hormone-producing gland is handled, and hormone levels that need support or replacement afterwards. Your surgeon and anaesthetist will go through the risks that apply to your operation before you consent.

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Educational only — this article is general information about adrenalectomy, not medical advice and not a diagnosis. Whether this treatment, or any treatment, is right for you is a matter for your own care team, who know your results and your history.