Adrenal Gland Disorders and Surgery

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What are Adrenal Gland Disorders?

Adrenal gland disorders include a group of medical conditions affecting the adrenal glands in Singapore. Adrenal glands are located on top of each kidney and produce hormones that support essential body functions, such as metabolism, immune system response, blood pressure, and managing the body’s response to stress. 

When adrenal glands fail to function optimally, it can result in various health issues, including common adrenal gland disorders, such as: 

  • Adrenal insufficiency: this condition, such as Addison’s disease, is primarily caused when adrenal glands fail to produce enough hormones, especially cortisol and aldosterone. 
  • Adrenal incidentalomas: these are often asymptomatic and unexpected adrenal gland masses or tumours, typically discovered during imaging studies, such as CT scans or MRIs, when they are performed for other medical reasons. These masses can be of different sizes, appearances, and characteristics. Adrenal incidentalomas (link to service page) can be benign or malignant. 
  • Adrenal tumours: adrenal tumours (link to service page) are either benign (noncancerous) or malignant (cancerous). An adrenal gland tumour can result in different symptoms depending on the hormone it produces. For example, pheochromocytoma is an adrenal gland tumour that produces excess catecholamines, leading to high blood pressure and other related symptoms.
  • Cushing's syndrome: this condition is characterised by an overproduction of cortisol. Adrenocorticotropic hormone (ACTH) made in the pituitary gland regulates the amount of cortisol the body produces. Some tumours can cause the ACTH to produce excessive cortisol, resulting in Cushing’s syndrome. Common symptoms include weight gain, high blood pressure, diabetes, and muscle weakness.
 Cushing's syndrome
Cushing syndrome is characterised by an overproduction of cortisol hormone.

What are the treatment options available for Adrenal Gland Disorders in Singapore?

The management of adrenal gland disorders involves a range of treatment methods and follow-up procedures. The three commonly used approaches for diagnosing, managing, and treating common adrenal gland disorders include:

  • Evaluation and follow-up of adrenal incidentalomas detected in scans
  • Hormonal workup of adrenal tumours
  • Laparoscopic (keyhole) surgery for adrenal tumours
Treatment/management option Description 
Evaluation and follow-up of adrenal incidentalomas detected in scansThe primary step in managing adrenal incidentalomas is to evaluate their nature and potential impact. This evaluation typically involves: Imaging studies to detect and characterise the size, appearance, and location of the mass.Monitoring growth and changes in the adrenal incidentaloma regularly. Assessing the patient's symptoms and medical history to decide if detailed investigation is needed. 
Hormonal workup of adrenal tumoursIt is essential to detect the hormonal activity of patients with adrenal tumours, as different types of adrenal gland tumours can produce different hormones. A hormonal work-up includes:Hormone level testing to investigate whether the tumour overproduces specific hormones, such as cortisol, to diagnose Cushing's syndrome. The aim is to identify the underlying cause of hormonal imbalances and plan treatment accordingly, which may include surgery or medical management. To diagnose and further classify adrenal disorders, your endocrinologist (link to about us) may perform dexamethasone suppression tests, aldosterone-to-renin ratio measurements, and catecholamine measurements
Laparoscopic (keyhole) surgery for adrenal tumoursIn severe cases where surgical intervention is required to treat adrenal tumours, medical professionals may suggest laparoscopic surgery, often referred to as "keyhole surgery.” It is a minimally invasive approach with several advantages, such as smaller incisions and reduced recovery times. 

How does Adrenal Gland treatment work? 

Adrenal gland treatment helps diagnose, manage, and, if required, surgically treat adrenal gland disorders. 

  1. Evaluation and follow-up of adrenal incidentalomas detected in scans work

This is a comprehensive initial procedure primarily utilised to examine the nature of the unexpected masses detected accidentally during a CT scan or an MRI. Once these masses are discovered, the first step is to further classify them by using additional imaging techniques. These additional imaging studies aim to assess the size, shape, and composition of these masses. 

The results of the primary evaluation may suggest a hormonal workup, which may include performing further blood and urine tests to identify hormone overproduction or any associated endocrine abnormalities. Moreover, to assess the risk, an endocrinologist (link to the about us) may conduct a detailed clinical assessment, including the patient’s medical history and diagnosis of their symptoms. 

Based on these findings, your endocrinologist will classify these incidentalomas into low or high risk to further decide on treatment and monitoring options. While low-risk masses may usually require periodic imaging follow-ups, high-risk or hormonally active incidentalomas may result in surgery or further monitoring. 

CT scans may be used to identify or classify adrenal incidentalomas further.
  1. Hormonal workup of adrenal tumours

Hormonal workup of adrenal tumours helps identify and classify hormone-related abnormalities within the adrenal glands. It typically involves blood and urine tests to measure the levels of specific hormones and their metabolites, which can vary from one type of tumour to another. 

For example, cortisol, aldosterone, renin, and catecholamines are often assessed. These hormone levels provide detailed information about the functionality and hormonal activity of the tumour. The results help diagnose conditions such as primary hyperaldosteronism, pheochromocytoma, or Cushing's syndrome. 

Furthermore, these tests can help identify the underlying cause behind hormonal imbalances and develop personalised treatment strategies. Based on these tests, your endocrinologist will decide if surgical intervention, medication, or any other intervention is required. 

  1. Laparoscopic (keyhole) surgery for adrenal tumours

Laparoscopy surgery for adrenal tumours is a minimally invasive procedure that helps remove the adrenal masses with precision and efficiency. The process begins with administering anaesthesia to the patient and then making small keyhole incisions in the abdomen. 

Your endocrinologist inserts trocars, including a laparoscope with a camera, through these incisions to get a clear view of the surgical site. They then utilise specialised instruments to dissect and remove the adrenal tumour while making sure that no or minimal damage is caused to the surrounding tissues. 

Once the tumour is removed successfully, the incisions are closed. The surgery results in less post-operative pain, smaller scars, and reduced recovery time. The surgery is especially beneficial for localised, non-invasive adrenal tumours. 

laparoscopic surgery
Laparoscopic surgery helps remove the adrenal masses by making smaller incisions.

What conditions can Adrenal Gland Treatment diagnose/treat in Singapore? 

S.No.Hormonal workupLaparoscopic (keyhole) surgery for adrenal tumours
Cushing's syndrome: this condition is caused by an excessive production of the hormone cortisol. 
A hormonal workup test, such as a 24-hour UFC test, is administered to measure the amount of cortisol excreted in the urine over 24 hours. If elevated levels of urinary-free cortisol are detected, further evaluations, such as the low-dose dexamethasone suppression test, and the midnight salivary cortisol test, are conducted to confirm the diagnosis.  
Adrenal tumours: the primary purpose of laparoscopic surgery is to remove tumours located on the adrenal glands. The aim is to prevent the spread of adrenal cancer (link to service page) in malignant cases or to alleviate hormonal imbalances and related symptoms in benign cases.
Primary hyperaldosteronism: when the adrenal glands produce too much aldosterone, it can cause a condition known as primary hyperaldosteronism. To measure the levels of aldosterone and renin in the blood, you may be required to undergo an Aldosterone-to-Renin Ratio test. An elevated aldosterone-to-renin ratio suggests an overproduction of aldosterone, which can lead to high blood pressure and electrolyte imbalances.Pheochromocytoma: these are adrenal tumours that overproduce catecholamines, which may disturb the body’s normal balance of stress response hormones, resulting in severe headaches, hypertension, sweating, and symptoms of panic attacks. In laparoscopic surgery for pheochromocytoma, the entire affected adrenal gland is removed.  
Pheochromocytoma: these are tumours that produce excess catecholamines. The plasma metanephrines and urinary metanephrines tests are the primary tests used for diagnosing these tumours. Plasma metanephrines measure the levels of metanephrines in the blood, which are breakdown products of catecholamines. Elevated plasma metanephrine levels indicate the presence of a catecholamine-producing tumour.The urinary metanephrines test assesses metanephrine levels in a 24-hour urine sample. Like the plasma metanephrines test, elevated urinary metanephrine levels suggest a catecholamine-producing tumour.Adrenal incidentalomas: a laparoscopic surgery may be used to treat adrenal incidentalomas (link to service page), especially if they are low-risk. In case of a malignant tumour, surgery may be recommended. 
Adrenal insufficiency (Addison's disease): This condition is caused when adrenal glands do not produce enough hormones, particularly cortisol. Cosyntropin Stimulation Test, also known as the ACTH stimulation test, is one of the common tests used to diagnose this condition. The test involves a series of blood samples taken before and after the administration of synthetic ACTH, called cosyntropin. 
Individuals with adrenal insufficiency typically exhibit a subnormal cortisol response, indicating an inability of the adrenal glands to produce an adequate cortisol response.
Cushing's syndrome: minimally invasive adrenalectomy has become one of the most preferred treatment options for Cushing’s syndrome. 
Hormone-producing tumours: adrenal tumours can produce various hormones, such as androgens or oestrogen. A hormonal work-up can identify these hormone-producing tumours, which can help determine targeted treatment, such as surgical removal of the tumour or hormone-suppressing medication.Aldosterone-producing tumours: in cases of primary hyperaldosteronism, laparoscopic surgery can be performed to remove the tumour causing excess aldosterone production, which can help normalise blood pressure and electrolyte balance.

What results can I expect from Adrenal Gland treatment in Singapore? 

Evaluation and follow-up of adrenal incidentalomas detected in a scan will help thoroughly assess the nature, size, and characteristics of these unexpected adrenal masses. In the case of low-risk and benign adrenal incidentalomas, patients may return to their regular activities relatively quickly. For high-risk adrenal incidentalomas, your doctor may suggest medication, minimally invasive surgery, or regular monitoring. 

A hormonal workup further guides the diagnosis and helps detect specific hormones, such as cortisol or aldosterone. It can help decide the most appropriate treatment option for managing hormonal imbalances. 

Laparoscopic (keyhole) surgery ensures precise tumour removal while minimising invasiveness. The surgery will result in smaller scars, reduced pain, and a quicker recovery for patients with adrenal masses, whether they are benign, hormonally active, or malignant. 

After the surgery, patients can usually go home within a day or two. It is essential to comply with the prescribed post-surgery care, such as pain management, prescribed medications (if needed), and gradual resumption of normal activities. In some cases, patients may require regular follow-up and imaging studies to avoid any recurrence and ensure a successful recovery. 

How many Adrenal Gland treatment sessions are needed?

The number of hormonal work-ups or laparoscopic surgery sessions required to treat adrenal disorders depends on the type of adrenal disorder, the size and location of the adrenal tumour or mass, whether the mass is benign or malignant, and the patient's overall health. 

In most cases, a single session of hormonal workup or laparoscopic surgery is enough to diagnose or remove an adrenal tumour. However, in more complex cases or when tumours are particularly large, or the hormonal test results are unclear or inconclusive, multiple sessions may be conducted to successfully treat the adrenal gland disorder. 

If you suffer from an adrenal gland disorder, schedule an appointment with ACE Specialist Surgery and Endoscopy for a detailed medical assessment and personalised treatment options.

What are the common symptoms of adrenal gland disorders?

Common symptoms indicating adrenal gland disorders include fatigue, weight changes, high blood pressure, and hormonal imbalances. 

Is laparoscopic surgery the standard treatment for adrenal tumours?

Laparoscopic surgery is often preferred for its minimally invasive nature, but treatment depends on the tumour's characteristics, size, and location. Open surgery may be necessary in some complicated cases. 

Can a hormonal workup help identify the underlying causes of adrenal disorders?

Yes, a hormonal workup can often detect the underlying causes of adrenal conditions. It can help identify hormone-producing tumours or autoimmune disorders, which are critical in deciding treatment options.

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Reyaz Moiz

Dr Reyaz Singaporewalla
Senior Consultant Endocrine and General Surgeon

MBBS (Bom), MS (Surg), DNB (Surg), FRCS (Edin), MMed (Singapore), FRCSEd.