What are Adrenal Glands?Adrenal glands are orange-colored organs located on top of both kidneys. Adrenal glands are about the size and shape of a fortune cookie. They are triangular and not round. Adrenal glands secrete several types of hormones and thus are part of the endocrine system. We all have two adrenal glands, but we can live just fine with only one (In fact, most people can live normally with less than half a normal adrenal gland). Adrenal glands usually do not cause problems, but they can develop tumors which require surgery.
What Do Adrenal Glands Do?
Adrenal glands secrete several types of hormones to help maintain blood pressure, salt balance and help in times of stress. Humans cannot live without adrenal glands, so if both adrenal glands are removed (very rarely necessary), then the patient needs to take medications and supplements to provide the necessary hormones.
Are Adrenal Tumors Common?Adrenal tumors are common, and they often cause problems. Autopsy studies have examined the frequency of adrenal tumors, and adrenal lesions (>1 cm) were identified in 6 % of patients. Similarly, the prevalence of "adrenal incidentalomas“ (these are adrenal tumors identified on scans performed for other reasons) is 4% when detected by abdominal CT or MRI. The incidence of adrenal tumors increases with age. For instance, the likelihood of detecting an unsuspected adrenal lesion on an abdominal CT scan in individuals between 20 and 29 years of age is only 0.2%, versus 7 % in individuals over 70 years of age. Since the Carling Adrenal Center is the leading center in the world for adrenal tumor disease, we see a lot of patients who present as children and young adults. However, adrenal tumors are more common in middle age to older patients.
The majority of adrenal tumors are clinically non-functioning, benign adrenocortical adenomas and often do not require surgical intervention. You need a surgeon and a healthcare team to determine who does and does not need an operation.
If you do need an operation, it may save your life. Yes, you may live longer, avoid high blood pressure (hypertension, and medications that make you feel sick and tired), diabetes, obesity, heart arrhythmia, heart attack and failure, and brain stroke. Surgery is definitely needed if you have an adrenal tumor that is overproducing hormones (functioning benign adrenal tumors may overproduce cortisol, aldosterone, catecholamines (adrenalines), and sex-steroid hormones). Malignant adrenal tumors: adrenocortical carcinoma (ACC), malignant pheochromocytoma, and other cancer metastasis to the adrenal, can also be cured by adrenal surgery.
The key to successful adrenal surgery. The key to having you and your adrenal mass treated correctly is to obtain guidance from the most experienced, thoughtful, and knowledgeable team possible. In brief, you (the patient) need to be aware that:
- The symptoms of adrenal hormone excess may be absent, subtle, atypical and/or masked by medications. You need to be screened (via blood and urine tests) to know if you have an adrenal tumor.
- The biochemical diagnosis of overproduction of hormones by adrenal tumors may be cumbersome due to drug interference, and very few physicians (even experienced doctors, including the most respected endocrinologists) do it correctly in a logical, efficient manner. You need the smartest, most experienced doctors around to evaluate you. You and your doctor need to arrive at the correct diagnosis while minimizing useless, expensive and unnecessary laboratory tests and expensive scans.
- Your adrenal tumor may have been found accidentally via a scan (ultrasound, CT, MRI, PET scans, etc) you were getting for some other reason. This is called an "adrenal incidentaloma”, meaning it was found incidentally, or surprisingly. This does not mean you (or your physician, radiologist, or endocrinologist) should ignore it. You need a thorough workup including measuring your adrenal hormones. You still may need surgery!
- Since surgery is the only possible curative treatment, you should spend a significant amount of time of research to find the best possible adrenal surgeon. The most important factor for a desirable outcome is your choice of adrenal surgeon.
How to Find the Best Adrenal Surgeon?Unfortunately, the average number of adrenal operations performed by "adrenal surgeons" in the United States per year is… 1 (one). You read that correctly. ONE! Yes, we are not kidding. Indeed, it would be a joke if it were not for the fact that you, or your loved one, depends on having an experienced surgeon for an optimal outcome.
In the Unites States, a high-volume adrenal surgeon according to scientific literature is regarded as a surgeon performing 5 or more adrenal operations (adrenalectomies) per year. This is akin to stating that you are an expert airline pilot if you fly an aircraft only 5 times a year. In a single day, the surgeons of the Carling Adrenal Center may perform more adrenal operations than your average surgeon in a career.