Adrenal Surgery in Ankara, Turkey

Adrenal surgery is performed to treat tumors or functional disorders that develop in the adrenal gland. This procedure aims to correct hormonal imbalances and prevent the progression of possible malignant diseases.

Surgery can be performed with an open or laparoscopic method. Laparoscopic adrenalectomy provides less pain and faster recovery thanks to small incisions. Open surgery is preferred for large tumors or invasive cases.

After surgery, patients’ hormone levels are monitored regularly. If necessary, cortisol or other hormone replacement therapies may be started. This process facilitates the body’s adaptation to the new hormonal balance.

Although the risk of complications after adrenal surgery is low, bleeding, infection, or a hormonal crisis may occur. With an experienced surgical team and regular follow-up, these risks are minimized and long-term success is achieved.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Adrenal Surgery in Ankara, to get information about Adrenal Surgery prices, the process, and the hospital where Adrenal Surgery is performed.

What Is the Adrenal (Suprarenal) Gland?

The adrenal gland is a small gland located on the upper part of the kidneys and is responsible for hormone production. It secretes hormones such as cortisol, adrenaline, and aldosterone, which regulate many vital functions in the body, including stress responses, blood pressure control, metabolism, immune response, and water-salt balance. Each individual has two, and its internal structure is divided into two parts: the cortex and the medulla.

What Is Adrenal (Suprarenal Gland) Surgery?

We can liken the adrenal glands to the executive floor of a company. This floor has two different departments: the outer part, the cortex, and the inner core, the medulla. Their functions are completely different, and therefore the problems they cause also differ.

The cortex, the outer layer, produces three groups of hormones that maintain the body’s basic balance. To remember them, we can use a simple code: “Salt, Sugar, and Sex.” The hormone aldosterone regulates the body’s salt balance and blood pressure. Cortisol, the stress hormone, regulates blood sugar and increases the body’s resistance to challenging situations. Androgens are precursors of sex hormones.

The medulla, the inner core, is like the body’s emergency button. In moments of danger or excitement, it secretes the hormones adrenaline and noradrenaline, which trigger the “fight or flight” response. These hormones make our heart beat faster, raise blood pressure, and sharpen all our senses.

When this delicate balance is disrupted due to a tumor or overgrowth in the glands, adrenal surgery comes into play. The aim of the surgery is to safely remove the tissue that disrupts this balance, produces hormones uncontrollably, or carries a risk of cancer, so that the body can function healthily again.

In Which Situations Is Adrenal (Suprarenal Gland) Surgery Performed?

When deciding on adrenal gland surgery for a patient, we consider three main factors: whether the mass in the gland produces excess hormones, whether it carries a risk of cancer, and its size.

The first and most common reason is hormone-producing, that is, functional tumors. These conditions, which disrupt the body’s chemistry, generally require surgical intervention regardless of the size of the mass. The main diseases leading to this situation are:

• Cushing Syndrome
• Conn Syndrome
• Pheochromocytoma

Cushing syndrome usually occurs when a benign tumor produces an excessive amount of cortisol. The body lives as if it is constantly in an alarm state. This leads to weight gain especially in the abdominal area, a rounding of the face, increased blood pressure and blood sugar levels, muscle weakness, and easy bruising of the skin. Conn syndrome is characterized by excessive aldosterone production and is one of the most important causes of treatment-resistant high blood pressure. Pheochromocytoma originates from the center of the gland and works like an “adrenaline bomb.” It can be life-threatening by causing sudden and severe blood pressure attacks, palpitations, sweating, and headache episodes.

The second important reason for surgery is malignant tumors or suspected cancer. In this case, the goal is to completely remove the disease from the body. The main conditions in this group are:

• Adrenocortical Cancer (ACC)
• Malignant Pheochromocytoma
• Metastatic Tumors

Adrenocortical cancer (ACC) is a rare but aggressive type of cancer originating from the adrenal gland tissue itself. The only chance in treatment is removing the tumor as a whole with clean surgical margins before it spreads to surrounding tissues. In cases where other organ cancers (such as lung or kidney) spread to the adrenal gland, that is, in the presence of metastasis, surgical removal may prolong the patient’s survival if the disease is limited to this area.

The third situation involves masses detected incidentally during a CT scan or ultrasound performed for another reason. For these masses, called “incidentalomas,” if hormone tests are normal, the most important criterion guiding our decision is the size of the mass. Masses smaller than 4 cm without suspicious features are generally monitored. However, since the risk of cancer increases significantly in masses exceeding 6 cm, we usually recommend surgical removal even if they do not produce hormones. Masses between 4 and 6 cm are a gray zone, and the decision is made on a patient-specific basis together with the other imaging features of the mass.

What Are the Risks of Adrenal (Suprarenal Gland) Surgery?

Every surgical procedure inherently has some risks, and adrenal gland surgery is no exception. However, with modern surgical techniques and an experienced team, these risks can be minimized. We can divide the risks of surgery into two categories: those that may occur during the operation and those that may occur afterward. As with every surgery, this operation also has its own potential risks. Some of these are:

• Bleeding
• Injury to surrounding organs
• Blood pressure fluctuations
• Risk of tumor dissemination
• Infection
• Hernia
• Blood clotting
• Adrenal insufficiency

Bleeding is one of the leading risks. Especially the right adrenal gland is connected to the vena cava, the body’s main large vein, by a very short and delicate vessel. This anatomy makes right-sided surgeries technically more challenging and increases the risk of bleeding. On the left side, due to its neighboring structures, there is a risk of injury to the spleen, pancreas, and their vessels:

Especially during pheochromocytoma surgeries, touching the tumor can release a large amount of adrenaline into the bloodstream. This may cause sudden and dangerous increases in blood pressure. However, with special preoperative medication preparation and the experience of the anesthesia team, this situation is managed successfully.

If a tumor suspected of being cancerous is fragmented during surgery or its capsule is torn, cancer cells may spread into the abdominal cavity. This can severely worsen the course of the disease. Therefore, in cases with a high suspicion of cancer, we usually prefer open surgery to eliminate this risk.

One of the most important postoperative risks is adrenal insufficiency. Especially in patients undergoing surgery due to Cushing syndrome, the cortisol-producing tumor has put the healthy gland on the other side “to sleep.” When the tumor is removed, the sleeping gland cannot wake up immediately, and the body is deprived of vital cortisol. This can lead to a dangerous condition called an “adrenal crisis,” characterized by low blood pressure, weakness, and nausea. To prevent this, we give patients cortisol medication from the outside after surgery, giving the healthy gland time to wake up.

How Is Adrenal (Suprarenal Gland) Surgery Performed?

Adrenal gland surgery is a delicate operation that requires meticulous planning and preparation. The process includes preoperative preparation, application of the surgical technique, and postoperative care:

First, the preoperative preparation period is a safety protocol. In every patient for whom surgery is decided, it is investigated in detail with blood and urine tests whether the gland produces hormones. If hormone excess is detected, the levels of these hormones are controlled with medication before surgery. For example, in patients with pheochromocytoma, starting special medications that balance blood pressure at least 10–14 days before surgery is vital to eliminate risks during the operation. Likewise, high-resolution CT or MRI provides invaluable information about the tumor’s location, size, and relationship with adjacent organs, allowing the surgeon to map out the route.

Your surgeon will choose the most appropriate method based on the characteristics of your tumor and your general health status. There are main surgical approaches used today.

• Laparoscopic (Minimally Invasive) Surgery
• Robotic Surgery
• Open Surgery

Laparoscopic (Minimally Invasive) Adrenalectomy is accepted today as the gold standard in the treatment of benign adrenal tumors. It is performed through a few small (0.5–1 cm) incisions in the abdominal wall using a camera and fine surgical instruments. Thanks to the magnified and clear image on the screen, the surgeon can perform the operation while seeing even the thinnest vascular and nerve structures. The biggest advantage of this method is that the patient experiences much less pain, the hospital stay decreases to 1–2 days, and the return to social life happens in days rather than weeks.

Robotic Adrenalectomy is a technologically more advanced version of minimally invasive surgery. The surgeon controls robotic arms through a console. Thanks to the three-dimensional image provided by the robot and precise instruments that can mimic—and even exceed—the wrist movements of the human hand, it offers a great advantage especially in tumors located in hard-to-reach areas or in partial resections aimed at preserving the gland.

Open Adrenalectomy is now a traditional method that we resort to only in special situations. Its most important indication is suspicion of or a definitive diagnosis of adrenocortical cancer (ACC). In this case, the aim is to remove the cancerous tissue as a whole together with the surrounding fatty tissue, without ever fragmenting or dispersing it. This approach, which we call “compliance with oncological principles,” is essential to minimize the risk of recurrence. In addition, open surgery may be required for giant masses exceeding 12–15 cm or for tumors that have spread to adjacent organs.

Postoperative Process After Adrenal (Suprarenal Gland) Surgery

The period after the surgery is at least as important as the operation itself. This phase is a transition and recovery period during which the body adapts to the new hormonal order.

If you had minimally invasive surgery, staying in the hospital for 1 or 2 nights is usually sufficient. Postoperative pain is minimal and can be easily controlled with simple painkillers. Getting up and walking as soon as possible will both speed up the return of normal bowel function and reduce the risk of clot formation in the legs. After open surgeries, the length of hospital stay and the recovery period are naturally a bit longer.

One of the most critical points of this process is managing hormonal balance. If you underwent unilateral adrenalectomy due to Cushing syndrome, you will need to meet your body’s cortisol requirement from the outside in pill form until your healthy gland, which we mentioned as “sleeping,” wakes up. This treatment is gradually reduced and discontinued over months under your doctor’s supervision by monitoring your blood levels. Patience is very important during this period.

If both of your adrenal glands have been removed, this means permanent adrenal insufficiency. However, this does not prevent you from living a healthy life. You will need to take the cortisol and aldosterone hormones that your body can no longer produce in medication form regularly for life. The dosage of these medications is adjusted to suit your daily life and health. You can think of this treatment like a diabetes patient using insulin; it is a replacement therapy that compensates for a deficiency and enables you to live a normal life.

What Should Patients Pay Attention to After Adrenal (Suprarenal Gland) Surgery?

Although adrenal gland surgery can mean a complete cure for many diseases, treatment usually does not end on the operating table. A successful operation is actually the first step toward a healthy future, and cooperation between the patient and the physician continues on this journey. Long-term follow-up is an integral part of treatment.

The follow-up process differs depending on the reason for surgery. For example, if you had surgery due to pheochromocytoma, there is a risk that this tumor may recur even years later or appear elsewhere in the body. Therefore, you generally need to be monitored with annual blood or urine tests for at least 10 years, and in some cases for life.

Our patients who undergo surgery for adrenocortical cancer (ACC) are placed on a much closer follow-up program. Due to the potential for recurrence, especially in the first few years, regular imaging tests (such as CT scans) are performed every 3–6 months.

To maintain a healthy life after surgery, it is necessary to pay attention to some important points.

• Regular doctor check-ups
• Annual hormone tests
• Necessary imaging studies
• Regular use of medications
• Knowing the “sick day rules”
• Carrying an emergency card

Especially for our patients who need to use cortisol medication for life, knowing the “sick day rules” is vital. When the body develops a fever, has an infection, experiences diarrhea or vomiting, or when another surgery is required, the need for cortisol increases. In these stressful situations, the dose of cortisol used needs to be temporarily increased. How to make this dose adjustment will be explained to you in detail by your doctor. In addition, it is a critical safety precaution for these patients to always carry an emergency card or bracelet indicating their condition, so that healthcare personnel can provide the correct intervention quickly in a possible emergency. Remember, you are not alone on this journey; with regular follow-ups and proper guidance, it is entirely possible to live a healthy and high-quality life.