Adrenalectomy
The surgical resection or removal of one or both adrenal glands, adrenalectomy is the treatment of choice for adrenal hyperfunction and hyperaldosteronism. It’s also used to treat benign and malignant adrenal tumors and as a secondary treatment of neoplasms elsewhere in the body that are dependent on adrenal hormonal secretions, such as cancers of the prostate and breast.
Because excessive levels of adrenal hormones can also stem from pituitary gland oversecretion of corticotropin, an adrenalectomy may be performed if primary treatment of the pituitary gland condition is unsuccessful in controlling the amount of corticotropin being secreted.
Procedure
After the patient is anesthetized, the surgeon will begin by using either an anterior (transperitoneal) or a posterior (lumbar) approach. The anterior approach gives the better view of both glands. In a unilateral adrenalectomy, the surgeon first identifies the gland and then dissects it free from the upper pole of the kidney. Wound closure follows. In a bilateral adrenalectomy, the surgeon identifies and dissects each gland separately and then closes the wound.
If the adrenalectomy is being performed because of a tumor, the surgeon will first explore the glands. If he finds a tumor, he either resects it or removes one or both glands, depending on the extent
of involvement. To remove a pheochromocytoma, the surgeon carefully excises the affected adrenal gland and palpates the abdominal organs for other tumors.
of involvement. To remove a pheochromocytoma, the surgeon carefully excises the affected adrenal gland and palpates the abdominal organs for other tumors.
Complications
Because the adrenal glands help maintain homeostasis and facilitate the body’s stress response, adrenalectomy carries a high risk of postoperative complications, including life-threatening acute adrenal crisis. (See Managing acute adrenal crisis, pages 18 and 19.) Other complications include hemorrhage, poor wound healing, hypoglycemia, electrolyte disturbances, pancreatic injury, and hypotension (with removal of the gland) or hypertension (after manipulation of the gland, which may trigger a sudden release of catecholamines, especially if a pheochromocytoma is present).
Key nursing diagnoses and patient outcomes
Ineffective protection related to inability to produce adrenal hormones. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
not experience hypotension, tachycardia, nausea and vomiting, restlessness, or other signs or symptoms of acute adrenal crisis
demonstrate protective measures, including compliance with adrenocorticoid replacement therapy, use of stress-reduction techniques, and early recognition and treatment of adrenal insufficiency.
Risk for infection related to suppressed inflammatory response caused by high adrenocorticoid levels preoperatively and use of adrenocorticoid replacement postoperatively. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
maintain a normal temperature, white blood cell count, and differential postoperatively
have an incision that will appear clean, pink, and free from purulent drainage
remain free from all other signs of infection.
Risk for injury related to dramatic fluctuations in blood pressure caused by sudden changes in adrenocorticoid or catecholamine levels or both. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
maintain a normal blood pressure
not experience the severe headaches, palpitations, or visual disturbances characteristic of hypertension or the light-headedness, pallor, or fainting characteristic of hypotension.
Nursing interventions
Expect to intervene as follows.
