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What is the adrenal gland?

Adrenal gland is a gland located above the kidneys, one on each side. It produces three kind of hormones

Catecholamines- like adrenaline and noradrenaline

Corticosteroids

Mineralocorticoids

When tumors arise from this gland it may be benign or malignant, and can produce one or more of these hormones

What are the common tumors of the adrenal gland?

The adrenal gland can produce both benign and malignant tumors. When the tumor is smaller than 4 cm these are generally bening like Pheochromocytoma or myelolipoma. But when the tumor is larger than 4 cm then the chance of cancer is higher and also these are more likely to produce one or more of these hormones.

 

How are they evaluated?

 

Generally these tumors are detected by ultrasonography, But for finer evaluation a MRI study is almost always needed.

 

Also to assess the production of hormones generally a 24 hour urinary collection of catecholamines and steroids is performed.

 

What is the best treatment for this tumor?

When these tumors are detected and the surgeon decides that these can be either malignant or are producing harmful excess hormones then surgery to remove these tumors is performed.

 

Although the standard treatment for these tumors was open surgery, but after the advent of laparoscopic surgery , nowadays most of these surgeries are performed by laparoscopy. Laparoscopy provides the advantage of minimal access and minimal pain, since the muscles and skin are mostly spared, but also provides excellent visualization of this deep seated gland. While open surgery needed a very large incision and retraction of the ribs to gain access to this gland, which resulted in severe post operative pain, laparoscopic surgery spares most of the pain.

Also the adrenal vein is much better seen by laparoscopic access as compared to open surgery therefore laparoscopic surgery has become the current preferred modality of surgery.

 

What follow up is needed for this tumor after surgery?

 

The removed tumor is always sent for post operative histopathology examination, If cancer is detected then a onco-medicine consultation is needed for adjuvant treatment. if the tumor was benign but produced vaso-active hormones then adequate endocrine intervention is needed in the post operative period to prevent a crisis of hormone deficiency in the post operative period.