Category Archives: Adrenalectomy

Exposing the right sided adrenal gland

Right Triangular Ligament of the Liver

  • Take down the right triangular ligament of the liver to expose the right adrenal gland.
  • Gland is right next to the vena cava (IVC = inferior vena cava)

Open right adrenalectomy

  • Mobilize the right lobe of the liver and the hepatic flexure of the colon
  • Enter the retroperitoneum
  • Reflect the duodenum and head of pancreas medially (Kocher maneuver)
  • The Kocher maneuver exposes the right adrenal gland and inferior vena cava.

Subclinical Cushing Syndrome

What is subclinical cushing’s syndrome?

  • subclinical hypercortisolism / may be observed with adrenal incidentaloma
  • autonomous clucocorticoid production without specific signs and symptoms of Cushing’s syndrome.
  • Much more common than classic Cushing’s syndrome
  • Patients have a high prevalence of obesity, hypertension, and type 2 diabetes.
  • Patients with incidentally detected adrenal masses who are about to undergo surgery should have testing for subclinical Cushing’s to avoid postoperative adrenal crisis..
  • Best test is short dexamethasone suppression test.

What is Cushing’s syndrome?

  • exaggerated facial roundness,
  • weight gain around the midsection and upper back
  • thinning of arms and legs.
  • stretch marks
  • hypertension
  • diabetes
  • Cushing’s syndrome occurs when exposed to high levels of the hormone cortisol for an extended period of time.
  • this can either occur with taking too much corticosteroid medication or when the body makes too much cortisol.
  1. Pituitary adenoma – secreting excess ACTH which stimulates the adrenal glands to make more cortisol
  2. Ectopic ACTH secreting tumor (ie. Lungs, pancreas, thyroid or thymus gland)
  3. Primary Adrenal Gland disease
  4. Familial Cushing syndrome

Diabetes type 1 vs. type 2

Type 1 = immune disorder.  Body attacks and destroys insulin producing beta cells in the pancreas.  Must take insulin.  Sometimes called insulin dependent or juvenile onset diabetes.

Type 2 = either the body doesn’t produce enough insulin or the cells ignore the insulin (resistant).  Sometimes called adult onset diabetes.  Obesity is the strongest risk factor for type 2 diabetes.

Adrenalectomy for subclinical Cushing’s Syndrome?

Adrenalectomy may lead to cure or better control of diseases associated with subclinical Cushing’s syndrome such as diabetes and hypertension

 Adrenal Incidentalomas

Most pose no clinical problems.