Signs You Need Adrenal Surgery

The clearest signs you need adrenal surgery are an adrenal tumor that produces excess hormones, a tumor that is large or growing, or a mass that shows features suggesting cancer. While many adrenal nodules are benign and require only observation, certain symptoms and diagnostic findings point directly toward surgical removal – a procedure called an adrenalectomy. Below, we explain how the adrenal glands work, the symptoms that signal a problem, and how doctors decide when surgery is the right step.

At American Endocrine, our team offers cutting-edge treatments, such as robotic surgery, for adrenal tumors.

Understanding the Adrenal Glands

You have two small, triangle-shaped adrenal glands – each about the size of a walnut – sitting on top of your kidneys. Despite their size, they play a large role in keeping your body balanced.

Each adrenal gland is composed of two distinct parts:

• The adrenal cortex (the outer layer) produces steroid hormones vital for life, including cortisol (regulates metabolism and the stress response), aldosterone (controls blood pressure by managing salt and water balance), and a small amount of sex hormones (androgens and estrogens).

• The adrenal medulla (the inner core) produces epinephrine (adrenaline) and norepinephrine (noradrenaline), which drive the body’s “fight or flight” response – increasing heart rate, blood flow, and glucose levels.

When the glands work normally, you don’t notice them. But when they make too much or too little of a hormone, the effects can spread across your entire body.

What Causes Adrenal Gland Problems?

Adrenal problems usually arise when a growth (tumor or nodule) forms on the gland, or the gland begins producing an abnormal amount of hormone – sometimes both at once. These tumors can be:

• Benign (non-cancerous): The vast majority are benign adenomas.

• Functional: The tumor actively produces excess hormones, leading to a specific endocrine disorder.

• Non-functional: The tumor does not produce hormones but may need attention if it becomes very large or shows suspicious features.

• Malignant (cancerous): Rarely, a tumor may originate in the adrenal gland (adrenocortical carcinoma) or spread from elsewhere (metastasis).

Many adrenal tumors are found by accident during a CT scan or MRI ordered for another reason – often called “incidentalomas.” Understanding the cause of your adrenal problem is the first step in deciding whether you need monitoring, medication, or surgery.

Symptoms Indicating Adrenal Problems

Symptoms of an adrenal disorder are tied directly to the specific hormone being overproduced, which is why a detailed medical history is critical.

General Symptoms of Adrenal Gland Disorders

• Unexplained weight changes (gain or loss)

• High blood pressure, especially if resistant to standard treatments

• Chronic fatigue or muscle weakness

• Mood swings, anxiety, or depression

• Changes in sleep or energy

• Headaches

• Excessive sweating

• Abnormal blood test results, such as low potassium

If you have several of these at once, or if standard treatments aren’t working, it may be time to look more closely at your adrenal glands.

Symptoms of Excess Aldosterone (Conn’s Syndrome)

The hallmark of Conn’s syndrome is hypertension. Watch for:

• Difficult-to-control high blood pressure: Often needing three or more medications.

• Low potassium levels (hypokalemia): May cause muscle cramps, weakness, frequent urination, and increased thirst.

• Headaches: Often related to severe hypertension.

• Fatigue: A general sense of being worn out.

Because hypertension is so common, Conn’s syndrome is often missed. Identifying it is critical, as surgery can cure the high blood pressure in many patients, allowing them to stop taking medication.

Symptoms of Excess Cortisol (Cushing’s Syndrome)

The effects of excess cortisol are widespread and can dramatically alter appearance and health:

• Weight gain: Particularly in the face (“moon face”), between the shoulders (“buffalo hump”), and around the abdomen.

• Skin changes: Thin, fragile skin that bruises easily; purple or pink stretch marks (striae) on the abdomen, thighs, and chest; slow healing of cuts.

• Muscle weakness: Especially in the upper arms and legs, making it hard to climb stairs or rise from a chair.

• Metabolic issues: High blood sugar, new-onset diabetes, or worsening of existing diabetes.

• Mood and cognitive changes: Irritability, anxiety, depression, and difficulty with concentration or memory.

• For women: Irregular menstrual periods and excess facial or body hair (hirsutism).

• For men: Decreased libido or erectile dysfunction.

Because cortisol affects so many systems, people with Cushing’s syndrome often see several doctors before the adrenal gland is identified as the source.

Symptoms of Excess Adrenal Medulla Hormones (Pheochromocytoma)

Pheochromocytoma symptoms often occur in dramatic spells or “attacks” caused by sudden adrenaline release. The classic triad includes:

• Severe headaches: Often pounding.

• Excessive sweating: Drenching sweats unrelated to heat or exercise.

• Rapid heartbeat (tachycardia) and palpitations.

Other symptoms accompanying these spells:

• Extremely high blood pressure (paroxysmal hypertension): Can spike to dangerous levels.

• Anxiety or a sense of doom.

• Tremors, shakiness, or flushed skin.

• Pale skin (pallor) during episodes.

• Shortness of breath.

• Abdominal pain or nausea.

Attacks can last from a few minutes to an hour and may occur multiple times a day or only a few times a year, sometimes triggered by stress, physical activity, or certain foods and medications.

Symptoms of Adrenal Cancer

When adrenal cancer is functional, it most often produces cortisol, leading to a rapid, severe presentation of Cushing’s syndrome. If non-functional, symptoms may only appear once the tumor grows large enough to press on nearby organs:

• Abdominal or flank/back pain

• A feeling of fullness or a mass in the abdomen

• Unexplained weight loss

• Rapid onset of hormone-related symptoms

Any adrenal mass that grows quickly or causes severe symptoms warrants prompt attention. Recognizing these signs early is one of the most important steps toward getting the right care.

Diagnosing Adrenal Gland Issues

A correct diagnosis is the foundation of a successful treatment plan, combining laboratory testing and advanced imaging interpreted by a specialist.

How Doctors Find Adrenal Gland Problems

Adrenal problems are usually found in one of two ways: a tumor discovered incidentally on a scan, or symptoms – like stubborn high blood pressure or unexplained weight gain – that prompt investigation. Once an adrenal issue is suspected, the process has two main goals:

1. Biochemical testing: To determine if the tumor is functional and which hormone it overproduces.

2. Imaging: To assess the tumor’s size, location, and characteristics.

At American Endocrine, this process is managed with precision. We require patients to provide all relevant medical records, including referrals from their endocrinologist or primary care physician, recent laboratory results, and imaging reports, so our specialist can conduct a thorough initial screening and prepare for your consultation.

Diagnostic Tests and Evaluation

• Blood and urine tests: The primary tools for checking hormone levels.

  • For Conn’s syndrome: Blood tests measuring aldosterone and renin levels.

  • For Cushing’s syndrome: A 24-hour urine collection for free cortisol, a late-night salivary cortisol test, or a low-dose dexamethasone suppression test.

  • For pheochromocytoma: Blood or 24-hour urine tests measuring metanephrines and normetanephrines, the breakdown products of adrenaline.

• Imaging studies:

  • CT (computed tomography) scan: The most common modality for a detailed view of the adrenal glands, showing the size and characteristics of the nodule.

  • MRI (magnetic resonance imaging): Also used, and particularly helpful for identifying pheochromocytomas.

  • Adrenal vein sampling (AVS): For Conn’s syndrome, this specialized procedure determines if one or both glands are overproducing aldosterone – crucial for deciding if surgery is the right option.

At American Endocrine, diagnostic tests are part of a careful evaluation before any treatment recommendation is made. If you are seeking clarity after a scan revealed an adrenal mass, a second opinion can help you understand your options.

Because a referral and recent lab and imaging reports are needed to prepare for your visit, gathering your records early helps avoid delays.

When Is Adrenal Surgery Needed?

Once an adrenal tumor is fully evaluated, the next step is deciding on the management. For many patients, surgery is the definitive solution.

Why Adrenalectomy Is Performed

An adrenalectomy is the surgical removal of one or both adrenal glands, performed for three primary reasons:

1. Hormone overproduction: To remove a functional tumor and cure the hormonal syndrome (Conn’s, Cushing’s, or pheochromocytoma).

2. Suspicion of cancer, or a large/growing tumor: To remove a tumor that is large (typically >4 cm), growing, or has suspicious features on imaging, allowing the tissue to be examined.

3. Symptomatic large tumor: To remove a large, non-functional tumor causing pain or pressure on other organs.

Recognizing these signs you need adrenal surgery helps you and your surgeon make a confident, informed decision.

Do Functional Adrenal Tumors Need to Be Removed?

In nearly all cases, yes. Surgery can often cure the hypertension and eliminate blood pressure medications.

• Cushing’s syndrome: Chronic cortisol excess leads to diabetes, osteoporosis, severe infections, and cardiovascular disease. Removing the tumor is the only way to reverse these effects.

• Conn’s syndrome: Removing the aldosterone-producing tumor cures or significantly improves hypertension and normalizes potassium levels, often allowing patients to stop blood pressure medication.

• Pheochromocytoma: Adrenaline surges can cause life-threatening hypertensive crises, stroke, or heart attack. Surgery is essential to prevent these events.

Non-functional tumors that are small and show no concerning features may simply be monitored over time instead. Your surgeon will explain which path is best for your situation.

Who Is a Candidate for Adrenal Surgery?

You may be a candidate for adrenal surgery if:

• Testing confirms a hormone-producing adrenal tumor

• Your adrenal mass is large or has grown on repeat imaging

• Imaging shows features that suggest possible cancer

• Your symptoms are significant and linked clearly to the adrenal gland

You must also be healthy enough to undergo general anesthesia and surgery. Dr. Hyunsuk Suh, an endocrine surgeon who specializes in complex adrenal masses and robotic surgery, evaluates each patient individually – considering overall health, the specifics of the adrenal condition, and personal treatment goals.

Next Steps if You Have an Adrenal Gland Tumor

1. Consult a specialist: Seek evaluation from a team that specializes in endocrine disorders – often an endocrinologist for the hormonal workup and an endocrine surgeon for the surgical evaluation.

2. Complete the biochemical workup: Blood and urine tests confirm whether the tumor produces hormones.

3. Gather all records: We require your referral, lab results, imaging reports (CT/MRI), and prior consultation notes, submitted before your appointment so your visit is as productive as possible.

4. Discuss the findings: Once all data is collected, you’ll have a consultation to review the diagnosis and treatment options. If surgery is recommended, the rationale, procedure, and what to expect are explained in detail.

Conclusion

Recognizing the signs you need adrenal surgery is essential for protecting your long-term health. While many adrenal tumors can be safely monitored, surgery is often recommended when a tumor produces excess hormones, continues to grow, causes significant symptoms, or shows features that raise concern for cancer.

A comprehensive evaluation with hormone testing, imaging, and specialist consultation can determine the best treatment approach. If you’ve been diagnosed with an adrenal mass or are experiencing symptoms of hormone imbalance, seeking expert care can help ensure an accurate diagnosis and timely treatment when surgery is needed.