The adrenal glands are situated above the kidneys. They are divided into layers that secrete several hormones crucial for survival. The outer layer, called the cortex, secretes three types of hormones: mineralocorticoids, glucorticoids and androgens, resposible for mineral balance, stress response, and male characteristics, respectively. The inner layer, called the medulla, secretes the "fight or flight" hormones epinephrine, or adrenalin, and norepinephrine. Removing the glands has the effect of removing the hormones, which must be replaced by supplements if both glands are removed. Some complications of removing the glands may have to do with achieving the correct balance of these hormones, other complications have to do with the procedure itself.
Complications During the Operation
The most common complications during the removal of the adrenal glands are damage to nearby organs, bleeding, and damage to blood vessels. The nearby organs damaged the most include the pancreas, the diaphragm, the liver, stomach, spleen, kidney and colon. Bleeding usually occurs due to damage to veins proximal to the adrenal glands. Damage to blood vessels in the area is typically from the surgeon accidentally tying a surgical suture or clip around an artery.
Complications After the Operation
Complications after the operation depend somewhat on why the operation was performed. If it was performed for Cushing's syndrome in which an adrenal gland was producing too much of the stress hormone cortisol, particular complications may occur. These include high blood sugar, increased risk of infection, poor wound healing and osteoporosis. Other complications may result if the surgery was performed to treat primary aldosteronism. In this disease production of aldosterone, a hormone that controls retention of minerals and water, is too high. A common complication is potassium levels being too high or too low. Removal of a tumor--a procedure called a pheochromocytoma--that produces hormones like adrenalin can lead to low blood pressure.
Other Complications
Standard risks are those expected to be present with any operation or administration of anesthesia. Some of the risks are greater in the very old or very young and those with chronic diseases. These standard risks include infections, bleeding requiring blood transfusions, blood clots in the legs that may travel to the lungs, damage to nearby organs, heart attacks, strokes, breathing poblems, allergic reactions to medicines, improper wound repair or hernias. Other complications more specific to removing the adrenal glands include pneumonia, pancreatitits and hiccups.
References
- "Complications of Urologic Surgery: Prevention and Management" Taneja, Smith, Ehrlich; 3rd Ed. 2001
- "Surgical Endoscopy"; The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery.; Brunt; February 2002
- Encyclopedia of Surgery: Adrenalectomy
