Adrenal Gland Surgery in Melbourne
Adrenalectomy is a surgical procedure to remove one or both adrenal glands, which sit above each kidney and produce hormones essential to regulating blood pressure, metabolism, and the body’s stress response.
Surgery is performed when a gland develops a hormone-producing tumour or a mass with features suspicious for malignancy that cannot be safely managed without removal.
At Specialist Surgical Group, our Melbourne-based endocrine surgeons perform adrenalectomy for conditions including primary aldosteronism (excess aldosterone), Cushing’s syndrome (excess cortisol), pheochromocytoma (excess catecholamines), and adrenal masses with indeterminate or malignant characteristics.
We use laparoscopic techniques wherever appropriate, operating through 3-4 small incisions with a camera to guide precise dissection and gland removal. Read more about our endocrine surgery services.
We consult from our Essendon and Bundoora clinics, with procedures performed at accredited hospitals in Melbourne. Most patients are discharged within 1-2 days of surgery.
Call us today at (03) 9466 7338 to book a consultation.
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We are located in the heart of Essendon and Bundoora.
Is adrenal gland surgery for you?
Adrenalectomy may be appropriate for you if:
- You have a hormone-producing adrenal tumour causing primary aldosteronism, Cushing’s syndrome, or pheochromocytoma that has been confirmed on biochemical testing
- You have an adrenal mass larger than 4-6 cm, or a smaller mass with imaging features suspicious for malignancy
- You have not achieved adequate blood pressure or metabolic control through medical management alone
- You have an adrenal mass that has grown significantly on surveillance imaging
- You understand that bilateral adrenalectomy, if required, will necessitate lifelong hormone replacement therapy
During your initial consultation, your surgeon will review your biochemistry, imaging, and medical history to determine whether adrenalectomy is the most appropriate treatment for your condition.
Potential benefits
- Improvement in blood pressure control. For patients with primary aldosteronism, adrenalectomy produces complete resolution of hypertension in approximately 37% of patients and partial improvement (requiring fewer medications) in a further 47%, with outcomes best in those with shorter duration of hypertension and no family history of high blood pressure [1].
- Resolution of hormone excess. Removing the source of cortisol, aldosterone, or catecholamine overproduction allows the body to restore hormonal balance and address the metabolic complications these conditions cause, including electrolyte disturbances, weight gain, and cardiovascular strain [2][3].
- Cardiovascular risk reduction. Untreated primary aldosteronism carries a significantly elevated risk of cardiovascular events compared to essential hypertension. Treating the underlying cause through surgery reduces this excess risk [4].
- Quality of life improvements. Patients commonly report improvements in energy levels, sleep quality, and general well-being following successful removal of a hormone-producing adrenal tumour [5].
- Minimally invasive recovery. The laparoscopic approach involves 3-4 small incisions, results in less post-operative pain than open surgery, and allows most patients to return to desk work within 1 week [6].
- Definitive treatment for adrenal malignancy risk. For adrenal masses with features suspicious for adrenocortical carcinoma, surgical removal is the only curative option and provides a definitive histological diagnosis [2].
- Safe and well-established technique. Laparoscopic adrenalectomy has a low rate of conversion to open surgery and a well-characterised complication profile when performed by experienced endocrine surgeons [6].
Potential risks
- Incomplete resolution of hypertension. While most patients with primary aldosteronism experience improvement in blood pressure following adrenalectomy, a complete cure is not guaranteed. Approximately 63% of patients continue to require some antihypertensive medication after surgery, particularly those with a longer history of hypertension, older age, or a family history of high blood pressure [1].
- Adrenal insufficiency. Patients with Cushing’s syndrome may experience temporary or prolonged adrenal insufficiency after surgery, as the contralateral gland may have been suppressed by chronic cortisol excess. Steroid replacement therapy is required in the post-operative period and tapered as the remaining gland recovers [3].
- Intraoperative blood pressure instability. Patients with pheochromocytoma are at risk of significant blood pressure fluctuations during surgery due to catecholamine release from the tumour. Careful pre-operative preparation with alpha-adrenergic blockade and close anaesthetic monitoring throughout the procedure is essential to minimise this risk [7].
- Conversion to open surgery. In some cases, the procedure needs to be converted from laparoscopic to open surgery due to bleeding, tumour size, adhesions, or unclear anatomy. Conversion rates are low in experienced hands, but the resulting longer hospital stays and delayed recovery are costly [6].
- Surgical complications. Bleeding, wound infection, and injury to adjacent structures, including the spleen, liver, or kidney, occur infrequently. Mortality from laparoscopic adrenalectomy is very low when performed at high-volume centres by experienced surgeons [6].
- Bilateral adrenalectomy implications. If both adrenal glands are removed, lifelong glucocorticoid and mineralocorticoid replacement therapy is required, along with patient education on adrenal crisis management during illness or physical stress [3].
Book a consultation today
(03) 9466 7338Meet our endocrine surgeon
Our endocrine surgeon is a Fellow of the Royal Australasian College of Surgeons with subspecialty training in endocrine, bariatric, and laparoscopic surgery, and has performed hundreds of thyroid, parathyroid, and adrenal procedures across Melbourne.
Your adrenalectomy journey
The following steps provide a brief overview of your adrenal gland surgery journey. Individual experiences will vary based on your specific health circumstances.
1. Initial consultation and health assessment
Your surgeon will review your biochemistry, hormone levels, and imaging studies, and discuss your symptoms and medical history. The likely diagnosis, the affected gland or glands, and whether a laparoscopic or open approach is most appropriate will all be assessed.
Further imaging, such as adrenal vein sampling for primary aldosteronism, may be recommended before finalising surgical planning.
2. Pre-operative preparation
You will receive detailed instructions covering fasting, medication management, and what to expect on the day.
Patients with pheochromocytoma require several weeks of pre-operative alpha-adrenergic blockade to stabilise blood pressure before surgery can safely proceed. Patients with Cushing’s syndrome may need specific steroid management planning.
All relevant specialist clearances will be coordinated before your procedure date.
3. The adrenalectomy procedure
Adrenalectomy is performed under general anaesthesia at an accredited Melbourne hospital and typically takes 1-3 hours, depending on the size and location of the tumour and whether one or both glands are removed.
Using 3-4 small incisions of less than 1 cm, a camera and specialised instruments are inserted to provide a magnified view of the operative field. The adrenal gland is carefully dissected away from the surrounding structures, including the kidney, major vessels, and adjacent organs.
For hormone-producing tumours, the gland is placed in a protective retrieval bag before removal to prevent cell spread. The incisions are closed with dissolving sutures or surgical glue.
4. Hospital recovery
Most patients wake comfortably and can eat and mobilise the same evening. Blood pressure, hormone levels, and electrolyte levels are closely monitored in the hours after surgery, particularly in patients with primary aldosteronism or pheochromocytoma.
Pain is generally mild and managed with simple analgesia. Most patients are discharged within 1-2 days, with medications reviewed and adjusted before leaving the hospital.
5. Long-term follow-up and supported monitoring
Your surgeon will see you 1-2 weeks after surgery to review your incision and initial hormone or biochemistry results. Blood pressure medications for primary aldosteronism are typically reviewed and reduced in the weeks following surgery as levels normalise.
Patients with Cushing’s syndrome will have cortisol levels monitored and steroid replacement gradually tapered. If adrenocortical carcinoma is confirmed on pathology, your care will be coordinated with an oncologist to discuss further treatment options.
Regular follow-up is essential for all adrenal conditions to confirm long-term hormonal remission.
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(03) 9466 7338Adrenalectomy FAQ
Most laparoscopic adrenalectomies take 1-3 hours, depending on the tumour’s size and position and whether one or both glands are removed. Your surgeon will give you a more specific estimate based on your imaging and planned approach.
Most patients stay 1-2 nights in the hospital following adrenalectomy. The length of stay depends on the specific condition being treated, post-operative hormone and blood pressure monitoring requirements, and how quickly you recover. Patients undergoing bilateral adrenalectomy may require a slightly longer stay.
Most patients can return to desk-based work within 1 week of surgery and resume full activities within 2-3 weeks. Heavy lifting should be avoided for approximately 4 weeks to allow the abdominal wall to heal. We will provide specific guidance based on your occupation and recovery.
The cost of adrenalectomy varies depending on the surgical approach, whether one or both glands are removed, the hospital used, and your private health insurance policy. For medically indicated adrenalectomy, Medicare provides a rebate on the surgeon’s fee under the relevant Medicare Benefits Schedule (MBS) item numbers.
Most patients with hospital-level private health insurance will have the main hospital costs covered, subject to any excess and applicable waiting periods. Out-of-pocket costs, which typically range from $2,000-$5,500 depending on your cover and the complexity of your case, will be itemised and quoted at your consultation. We encourage you to contact your insurer before booking.
Many hormone-related symptoms begin to improve within days of surgery. Blood pressure often improves within the first few weeks as aldosterone or cortisol levels normalise.
Complete resolution of symptoms, including fatigue, metabolic changes, and cardiovascular risk factors, may take several weeks to months as your body adjusts to normal hormone levels. Your surgeon will monitor your progress at follow-up appointments.
Bilateral adrenalectomy is sometimes required for conditions such as bilateral pheochromocytoma or ACTH-independent bilateral adrenal disease. Removing both glands results in permanent adrenal insufficiency, requiring lifelong daily replacement with glucocorticoids and mineralocorticoids.
While this requires careful long-term management, most patients feel significantly better after surgery once their hormone replacement is optimised. Patient education on recognising adrenal crisis and emergency steroid management is an essential part of post-operative care.
This depends on which gland is removed and why. Patients having a single adrenal gland removed typically do not need long-term hormone replacement, as the remaining gland compensates. Patients with Cushing’s syndrome may require temporary steroid replacement while the suppressed contralateral gland recovers. Patients undergoing bilateral adrenalectomy will require permanent hormone replacement. Your endocrine team will manage this carefully in the post-operative period.
Long-term follow-up is important for all adrenal conditions. Blood pressure medications are reviewed and adjusted in the weeks after surgery for primary aldosteronism. Hormone levels, including aldosterone, cortisol, or catecholamine metabolites, are rechecked at 4-6 weeks to confirm remission. If adrenal malignancy is identified, oncology follow-up with imaging surveillance is arranged. Most patients transition to less frequent monitoring once hormonal remission is confirmed and stable.
These are three distinct endocrine surgery procedures addressing different glands and conditions.
Thyroid gland surgery treats thyroid cancer, nodules, goitre, and hyperthyroidism. Parathyroid gland surgery corrects overactive parathyroid glands that cause elevated blood calcium levels. Adrenalectomy is generally a longer and more involved procedure than parathyroidectomy, reflecting the deeper location of the adrenal glands and the complexity of pre-operative preparation for hormone-secreting tumours.
All three procedures are performed by our endocrine surgery team and can be discussed at the same consultation if relevant.
Medical disclaimer
The information on this page is for general educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendations, and does not create a doctor-patient relationship. Individual circumstances vary significantly, and nothing on this page should be used as a substitute for personalised advice from a qualified medical professional.
If you have concerns about your health, please seek medical attention promptly. To discuss your specific condition and treatment options with our team, please book a consultation by calling us at (03) 9466 7338.
References
[1] Williams TA, Lenders JW, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5(9):689-699. https://doi.org/10.1016/S2213-8587(17)30135-3
[2] Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur J Endocrinol. 2016;175(2):G1-G34. https://doi.org/10.1530/EJE-16-0467
[3] Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(8):2807-2831. https://doi.org/10.1210/jc.2015-1818
[4] Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension. 2013;62(2):331-336. https://doi.org/10.1161/HYPERTENSIONAHA.113.01243
[5] Ahmed AH, Gordon RD, Sukor N, et al. Quality of life in patients with bilateral primary aldosteronism before and during treatment with spironolactone and/or amiloride, including a comparison with our previously published results in those with unilateral disease treated surgically. J Clin Endocrinol Metab. 2011;96(9):2904-2911. https://doi.org/10.1210/jc.2011-0138
[6] Conzo G, Tartaglia E, Gambardella C, et al. Minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg. 2016;28(Suppl 1):S118-123. https://doi.org/10.1016/j.ijsu.2015.12.042
[7] Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(6):1915-1942. https://doi.org/10.1210/jc.2014-1498