Adrenalectomy is a surgical procedure that involves the removal of one or both adrenal glands, which are responsible for producing hormones that regulate various bodily functions. Adrenalectomy may be performed for a number of reasons, including the presence of tumors or other abnormalities in the adrenal gland. Recovery from adrenalectomy can be challenging, but with proper care, individuals can regain normalcy in their lives rapidly.

The best adrenal operation for almost all patients (>98%) is the Mini Back Scope Adrenalectomy (MBSA).

Two main reasons that the MBSA lead to faster recovery to normal life after adrenalectomy are:

• There is less pain following the Mini Back Scope Adrenalectomy (MBSA). Many patients only take Tylenol (acetaminophen) after the operation. Very few patients need strong painkillers.
• The recovery is faster following the Mini Back Scope Adrenalectomy (MBSA). Most people return to work within a few days. You can start your hobbies and exercises a lot faster following a MBSA, whether you engage in walking, running, biking, yoga, weightlifting, skiing, tennis, golf, or any other workouts.

Read more about why the mini back scope adrenalectomy (MBSA) is the best adrenal operation.

Life After Adrenalectomy

Recovery process after adrenalectomy

The recovery process after adrenalectomy can vary depending on the type of surgery performed and the patient’s overall health status. After the operation you will spend the next couple of hours waking up and you may not even remember much of this period of time. However, at lunchtime or in the afternoon you will feel very good. You will spend less than 23 hours in the hospital in most cases. You will be able to eat, go for a walk in the hospital hallway. Most patients have very minimal pain and usually just take plain Tylenol and ibuprofen.

The morning after the operation you will have what is called a Cosyntropin stimulation test. This is a simple lab test, but it is performed to assess the cortisol production which is proof that the remaining adrenal gland works perfectly. Most patients leave the hospital around 9 o’clock in the morning.

In general, the first few days after surgery are focused on managing pain and ensuring that the patient’s vital signs remain stable. The blood pressure and heart rate may normalize quickly after removal or some adrenal tumors and needs to be measured regularly. The patient may remain in the hospital overnight, and >98% go home within 23 hours of the operation. Patients with very large tumors (>10 cm) may need a few more days, depending on the extent of surgery and the individual’s response to treatment.

After being discharged from the hospital, patients will need to follow a strict, postoperative care regiment, which typically includes taking medications and measuring the blood pressure and heart rate (as it normalizes). Patients may go for walks outside or on a treadmill, as well as ride on an exercise bike, but avoiding strenuous activities (including lifting anything heavier than 20 lbs.; 10 kg) for about 2 weeks. In general, exercises that engage the core (sit ups, pull ups, tennis, running and skiing) should be avoided for at least 2 weeks.

As the body heals, patients will gradually be able to resume normal activities. However, it is important to know that recovery from adrenalectomy can take several weeks or even months.

• Patients with pheochromocytomas (adrenaline-producing tumors) tend to normalize their symptoms, and high blood pressure fastest, within days to weeks.
• In patients with aldosterone-producing tumors (Conn's syndrome), the low potassium usually normalizes first, then the blood pressure will start improving over weeks to a few months.
• The recovery from the toxic effects of cortisol (adrenal Cushing’s syndrome) tends to take the longest. Some patients may require several weeks, and occasionally months to feel better. These patients may also need to be on a short-term steroid supplementation (hydrocortisone) until the normal adrenal gland “wakes up” after having been suppressed by the high toxic cortisol levels from the tumor. Weight loss may be gradual for up to a year, and scientific studies of bone mass show recovery for 3-5 years after adrenalectomy in those with osteopenia and osteoporosis.

Change in medications after adrenalectomy

Many patients wonder: Will my medications change after adrenalectomy?

Well, it depends on what type of tumor you have.

• Aldosterone over-production (Conn’s syndrome or primary hyperaldosteronism)

People with aldosterone-producing adrenal tumors will typically require multiple medications to treat their high blood pressure, often including the potassium-sparing diuretic, spironolactone (or eplerenone). You may also be taking potassium tablets. It is important to stay on these medications up to the time of your operation, which will be weaned off by your doctors after successful adrenalectomy.

AFTER SURGERY – You will be instructed by Dr. Carling and his team to start dialing back on these medications. It usually takes weeks to months to see the full effect of surgery. Measure your blood pressure and heart rate at least twice a day and keep a good record so you can compare how your blood pressure gets better after surgery.

• Cortisol over-production (Cushing’s syndrome)

People with cortisol producing adrenal tumors will also need to continue taking their medications up to the day of surgery.  After removal of the adrenal gland that is responsible for the excess cortisol production you may require a short course of oral steroids (typically hydrocortisone). 

AFTER SURGERY – You will be instructed by Dr. Carling and his team whether you need to take this medication for a few weeks, or not. Your blood pressure, weight and blood sugar are likely to get better so keep good records of all these and report the improvements back to your doctor 4 weeks after surgery.

• Adrenaline over-production (Pheochromocytoma)

People with a pheochromocytoma will sometimes need medication before surgery to block or dampen the “fight-or-flight” hormones that are being over-produced by the adrenal tumor.  Typically, doxazosin (a class of medications called an alpha-blocker) is used for at least two weeks to prepare your body for adrenal gland surgery. 

AFTER SURGERY – The high blood pressure in pheochromocytoma is usually immediately cured in the operating room. Thus, it is likely you can come off all your blood pressure medications already in the hospital. You will be instructed by Dr. Carling and his team which medications you should stop when going home.

Figure 1: This is how great a patient looks and feels 3 months after being cured of her subclinical Cushing’s syndrome (too much cortisol) and resuming a normal life after adrenalectomy.

During this time, patients may experience fatigue, weakness, and other symptoms that can make it difficult to carry out daily tasks. It is important for patients to listen to their bodies and pace themselves, accordingly, taking breaks as needed and avoiding overexertion.

Adapting to regular life after adrenalectomy

Returning to regular life after adrenalectomy can be a significant adjustment for patients. In addition to physical changes such as fatigue and weakness, patients may also experience emotional and psychological changes, such as anxiety and depression. These changes can be challenging to manage, but there are several strategies that can help. Often these symptoms are from the tumor producing too much tumor, and these symptoms improve after surgery. However, this period of recovery can still be associated with emotional and psychological changes.

One of the most important strategies for adapting to regular life after adrenalectomy is to establish a daily routine. Patients should aim to establish a consistent schedule for activities, such as eating, sleeping, and exercise. This can help to regulate the body‘s natural rhythms, and promote a sense of stability and normalcy.

In addition to having routines, patients should also make an effort to engage in activities that they enjoy. This can help to promote the sense of purpose of fulfillment, which can be especially important during the recovery process. Patients should also make an effort to stay connected with friends and family members, who can provide emotional support and encouragement.

Many patients ask when they can return to healthy sexual activity with their spouse after adrenal surgery and the Mini Back Scope Adrenalectomy (MBSA). The good news: pretty much immediately!

Read more about sex, sexual dysfunction, and adrenal tumors.

Figure 2: Slowly but steadily get back to activities you enjoy - like skiing!

Another important aspect of adapting to regular life after adrenalectomy is to manage stress. Patients may experience a higher level of stress than usual during the recovery process, and it is important to find healthy ways to cope with the stress. This can include activities such as meditation, prayer, deep breathing exercises, which can help to promote relaxation and reduce stress levels.

Finally, patients should be patient with themselves and realize it takes some time to adjust to the new normal. Recovery after adrenalectomy can be a gradual process and it is important to take things one day at a time. Patients should also remember to celebrate their accomplishments, no matter how small. This can help to promote a sense of progress and accomplishments.

Conclusions

Recovery from adrenalectomy can be a challenging process, but with proper care and management individuals can adapt to a regular life and regain a sense of normalcy. The recovery process after the Mini Back Scope Adrenalectomy (MBSA) is much faster than any operation through the belly (laparoscopic), with and without the robot. The recovery can take several weeks or even months and it is important to be patient. To allow for most efficient aftercare, ensure you have an appointment with your medical doctor (most commonly your endocrinologist, nephrologist, or primary care doctor) about 4 weeks after the operation.

Figure 3: The beautiful Hospital for Endocrine Surgery in Tampa, Florida is home to the Carling Adrenal Center, as well as the Norman Parathyroid Center and the Clayman Thyroid Center. Together, they make up the world's highest volume endocrine surgery practice.

Dr. Tobias Carling, of the Carling Adrenal Center, is one of the world's leading experts in adrenal gland surgery. Dr. Carling performs more adrenal operations than any other surgeon in America. Dr. Carling left Yale University in 2020 to open the Carling Adrenal Center in Tampa, Florida.

To discuss the details of your case with Dr. Carling and become his patient, fill out the new patient form and he will be in touch with you shortly.

Additional Resources: 

• Learn more about the Carling Adrenal Center
• Learn more about Dr. Tobias Carling
• Learn more about our sister surgeons at the Norman Parathyroid Center, Clayman Thyroid Center and Scarless Thyroid Surgery Center
• Learn more about the Hospital for Endocrine Surgery