44-year-old Mrs Madhu (name changed), experiencing weakness and dizziness for several days, consulted a physician near her home. A large tumour arising from the right adrenal gland, measuring approximately 8 cm in size, was detected on a CT Scan.
(Adrenal Glands are small triangle-shaped glands located on each kidney.)
She then visited Sarvodaya Hospital, Sec 8, Faridabad, where the doctors examined her condition and found that the tumour was located close to the liver and was pushing the right kidney downward. Considering its large size and suspicious malignant nature, the patient was counselled regarding the need for surgical tumour removal.
A technically challenging Laparoscopic Adrenalectomy (minimally invasive surgery to remove one or both of the small adrenal glands) was successfully performed by Dr Ankur Bhatnagar, Senior Consultant & Head (Unit - I) – Renal Transplant & Urology and Dr Devpriya Mitra, Consultant – Renal Transplant & Urology and team, achieving complete removal of the tumour while preserving the surrounding organs.
The surgery was completed in approximately 2 hours, with an estimated blood loss of only 50 mL. The patient was discharged after two days, was tolerating her diet well and had no major postoperative complications.
Adrenal tumours are relatively uncommon, and managing a tumour as large as 8 cm can be particularly challenging because of the important structures surrounding the adrenal gland, including the liver, kidneys, blood vessels and more.
In this case, the tumour was on the right side, where it was closely associated with the liver, right kidney and major blood vessels.
The size and location of the tumour increased the complexity of the surgery and raised concern about its malignant potential. After detailed evaluation and counselling, surgical removal was planned rather than delaying treatment.
The sample was also sent to the lab for biopsy.
The right adrenal gland is located deep in the upper abdomen, close to several vital structures.
In this case, the large tumour was:
One of the most important steps during the surgery was careful mobilisation of the liver (a surgical procedure that frees the liver from its surrounding tissue attachments and ligaments to allow clear access during operations).
This provided adequate exposure of the adrenal tumour and allowed the surgical team to carefully dissect the tumour while minimising the risk of liver injury.
The surgeons also had to maintain meticulous vascular control because of the tumour's proximity to major blood vessels.
Despite these challenges, the tumour was successfully removed through a minimally invasive laparoscopic approach.
The surgical team performed a laparoscopic adrenalectomy, a minimally invasive procedure in which the affected adrenal gland and tumour are removed through small abdominal incisions using a laparoscope and specialised surgical instruments.
The procedure required precise dissection around the tumour and careful separation from the liver, kidney and surrounding vascular structures.
The patient was already anaemic before surgery and therefore required one unit of blood transfusion. Apart from this, blood loss during the procedure was minimal, and there were no major surgical complications.
Following surgery, the patient recovered well. She was able to tolerate her diet and was discharged from the hospital within two days.
The adrenal glands are small glands located above each kidney. They produce important hormones that help regulate several functions in the body, including blood pressure, metabolism and the body's response to stress.
An adrenal tumour is an abnormal growth arising from the adrenal gland. These tumours can be benign or malignant, and some can also produce excess hormones.
The management of an adrenal tumour depends on several factors, including its size, appearance on imaging, hormone activity, symptoms and the possibility of malignancy.
The size of an adrenal tumour is one of the factors doctors consider while assessing its risk.
A large adrenal mass, particularly one with suspicious imaging characteristics, requires careful evaluation for malignancy. Delaying treatment in a tumour with concerning features may allow it to grow further or affect nearby organs.
Large tumours can also cause pressure on surrounding structures. As the tumour increases in size, it may come into close contact with the liver, kidney, blood vessels and other abdominal structures, making subsequent surgery more complex.
Therefore, patients with large or suspicious adrenal tumours should undergo timely evaluation by an experienced multidisciplinary team to determine the most appropriate treatment.
Get reliable medical advice anytime, anywhere.
