adrenalectomy /ədrē′nəlek″təmē/ [L, ad + ren; Gk, ektomē, excision] , the total or partial surgical resection of one or both adrenal glands. It is performed to reduce the excessive secretion of adrenal hormones caused by an adrenal tumor or a malignancy of the breast or prostate. See also Addison’s disease, Cushing’s syndrome. ▪ METHOD: The incision is made under the twelfth rib in the rear flank area with the patient under general anesthesia. Preoperative laboratory tests include electrolytes, fasting blood glucose, glucose tolerance, and fluid states and adrenergic and blockade if needed. ▪ PATIENT CARE CONSIDERATIONS: Hemodynamic monitoring and preoperative steroid replacement are needed. Before surgery a nasogastric tube may be inserted. Careful intraoperative positioning is necessary for the patient with Cushing’s syndrome because of osteoporosis, fragile bones, and muscle wasting. In patients with pheochromocytoma, intraoperative manipulation of an adrenal tumor can cause a surge of catecholamines, resulting in a blood pressure increase. Postoperative care focuses on maintaining blood pressure with vasoconstrictors or vasodilators as needed, giving replacement doses of corticosteroids, and monitoring fluid and electrolyte status. ▪ OUTCOME CRITERIA: With appropriate medications, resolution of symptoms is achieved in nearly all cases related to excessive secretions. When both glands are removed, the maintenance dosage of steroids continues for life. The prognosis for malignancies is usually poor.
