Adrenalectomy

Adrenalectomy is recommended when:

• A confirmed adrenal tumor is the cause of Cushing's disease and medical management has failed or is not preferred
• An adrenal mass is larger than 2 cm, growing on serial imaging, or shows signs of vascular invasion on CT — regardless of whether it is actively secreting hormones
• A pheochromocytoma (tumor of adrenaline-producing cells) has been identified and is causing dangerous surges in blood pressure
• An adrenal carcinoma (malignant tumor) is present and appears resectable

In contrast, adrenal tumors causing Cushing's disease that are small and well-contained may be managed medically (with trilostane or mitotane) — surgery is weighed against your individual pet's health status and the tumor's characteristics.

Adrenalectomy is performed under general anesthesia with continuous blood pressure monitoring and direct arterial line measurement. The steps:

• An abdominal incision provides direct access to the retroperitoneum (the space behind the abdominal organs where the adrenal glands lie)
• The adrenal gland and its tumor are dissected carefully free from the surrounding fat, vessels, and kidney; when tumor thrombus (clot extension) is present in the vena cava, vascular control and extraction of the thrombus may also be required
• Hemostasis is meticulous — even minor bleeding from surrounding vessels is significant given their size and proximity
• The abdomen is closed in layers and the patient remains under close monitoring in the ICU recovery area

Minimally invasive (laparoscopic) adrenalectomy may be considered for small, non-invasive tumors in dogs — your surgeon will discuss this option based on CT findings.

Pre-surgical preparation for adrenalectomy is thorough and often takes several days to weeks:

• CT of the abdomen and chest to map tumor size, invasion, and metastasis
• Complete blood panel including electrolytes, clotting times, and cortisol measurements
• For Cushing's patients: pre-treatment with trilostane or mitotane for four to eight weeks to normalize cortisol and reduce surgical risk
• For pheochromocytoma: pre-treatment with alpha-adrenergic blockers for two weeks to prevent hypertensive crisis during surgery
• Pre-anesthetic cardiovascular assessment given the high blood pressure risk

Withhold food the evening before surgery. The anesthesia team is briefed on the patient's specific hormonal status to prepare for intraoperative blood pressure fluctuations.

Adrenalectomy patients are hospitalized for two to five days post-operatively. The main concerns after surgery:

• Hypocortisolism (adrenal insufficiency): when the remaining adrenal gland has been suppressed by the tumor's overproduction, it may be temporarily unable to function — corticosteroid supplementation (hydrocortisone) is given perioperatively and tapered over weeks
• Blood pressure instability: particularly for pheochromocytoma patients; continuous monitoring during hospitalization
• Thromboembolism (blood clot) risk: Cushing's patients have pro-clotting blood changes; anticoagulant precautions are used
• At home: activity restriction for three to four weeks; e-collar to protect the incision; follow-up cortisol testing and gradual steroid taper

Adrenalectomy carries higher perioperative risk than most soft-tissue surgeries, which is why patient selection, pre-surgical preparation, and intensive monitoring matter so much. Significant risks include:

• Major intraoperative hemorrhage from the vena cava or other major vessels
• Post-operative adrenal insufficiency requiring steroid supplementation
• Thromboembolism, particularly in Cushing's patients
• Acute pancreatitis in the post-operative period
• Tumor metastasis (present in some adrenocortical carcinomas)

Despite these risks, for the right patient — particularly a dog with a discrete, non-invasive adrenal adenoma — adrenalectomy offers the only genuine cure and frequently produces a dramatic improvement in quality of life as Cushing's signs resolve. The surgical team will provide a frank, individualized risk discussion before you decide.