Surgery of the adrenals
1. Big picture
Adrenal surgery is mainly about recognizing hormonally active adrenal disease, excluding malignancy, preparing the patient safely, and choosing the correct adrenalectomy approach.
The examiner usually wants you to answer:
- Is the adrenal lesion functional or non-functional?
- Is it benign or malignant?
- Does it need surgery or observation?
- What must be done before adrenalectomy, especially for pheochromocytoma and Cushing syndrome?
- What are the major operative risks and postoperative endocrine complications?
The adrenal glands are small, but adrenal disease can be surgically dangerous because tumors may cause hypertensive crisis, severe hypokalemia, cortisol excess, adrenal insufficiency, bleeding, and malignancy.
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