Patients do very well after laparoscopic adrenalectomy. There is relatively little discomfort, usually well controlled with moderate narcotic based medication. Patients are up walking the evening of surgery. A regular diet is started once post-op nausea is resolved. Essentially all patients, except those with pheochromocytoma go home the day following surgery. All wounds are closed with skin glue and the patient may shower the morning after surgery. Activity after surgery depends on patient comfort. Patients should not exercise until seen in the office about 10 days post-op. Normal daily activity is encouraged. Patients may return to office work as their comfort allows, usually a week to 10 days after surgery. Those with a physically demanding job usually return to work around 3 weeks post-op.
Fever after surgery is not uncommon. If the patient feels well and is with out any other symptoms then tylenol and deep breathing are recommended. However, fever over 101 accompanied by productive cough, painful or difficult breathing or redness and drainage from the wounds may indicate a significant problem and the office should be called. Persistent calf pain or swelling could indicate a blood clot and the office should be called. Specific post-op issues depend on the underlying disease process that required adrenalectomy.
Once the patient is hemodynamically stable and feels well they are discharged . The phenoxybezamine is stopped at the time of surgery. If the patient was given labetalol, the patient will commonly go home on a reduced dose and then weaned off over a week to 10 days. Some dizziness and fatigue are common but if, debilitating, the patient should contact the office.
After adrenalectomy for Conn’s syndrome the patients high blood pressure is usually improved. However, complete immediate resolution of blood pressure problems is uncommon. Patients are typically discharged on reduced doses of their antihypertensive medication. Complete withdrawal of medication may take some time and is directed by the patient’s endocrinologist. Potassium supplements are generally stopped at surgery.
As we have discussed earlier, Patients with Cushing’s syndrome have elevated glucocorticoid levels which lead to suppressed function of the normal adrenal gland. When the abnormal gland is removed the remaining adrenal gland will not work normally immediately. Therefore, after surgery the patient is started on steroid therapy,usually prednisone. This is continue for 3-6 months and is slowly weaned as the remaining adrenal glands resumes normal function. This is done under the direction of the endocrinologist.
Regardless of the reason for adrenalectomy there is a very remote possibility that the remaining adrenal gland may not function normally. This is very rare. Symptoms of adrenal insufficiency include weakness, profound fatigue, loss of appetite, muscle aches, abdominal pain, confusion and low blood pressure. These symptoms are largely non-specific. Patients may experience one or two symptoms to a mild degree as part of the usual post-op recovery. Multiple symptoms that worsen over time could be adrenal insufficiency and should be reported to the office.