Question: Are the different surgical procedures for bilateral adrenalectomies equivalent and is it known immediately after surgery if any tissue capable of making cortisol is left? 

Answer: If a patient has to undergo removal of both adrenal glands (bilateral adrenalectomy) to remove the source of excessive cortisol production, the surgery can be performed in 3 different ways: the abdominal approach with a single incision, the posterior approach in which incisions are made between the ribs on each side and with laparoscopic removal. The decision of which surgical procedure to use will differ from one patient to another depending on the size of the glands and other factors.

Laparoscopic adrenalectomy has become more popular in recent years and has been quite successful in removing all of the adrenal tissue in some patients and not as successful in others. As with any surgical technique, the success rate of the abdominal, posterior or laparoscopic approach is dependent on the skill and experience of the surgeon. Patients should ask the surgeon how many such procedures he or she has performed and what is the success rate.

After both adrenal glands are removed, the blood cortisol level can be measured to see if the operation was successful if the patient is not taking hydrocortisone. In this circumstance the patient should be given prednisone or dexamethasone since hydrocortisone is measured in the blood test as cortisol. Regardless of the type of surgical procedure, there is a small possibility that a patient may have adrenal tissue elsewhere, in women it is most commonly found in the ovaries, this is called an adrenal rest. Unfortunately, there is not a precise method to identify adrenal rest tissue before adrenal surgery.

By Dr. Mary Lee Vance MD (Summer, 1999)