What to expect

Before surgery

Workup before adrenalectomy is focused and usually already under way by the time of surgical consultation:

Hormone testing. At minimum, plasma or urinary metanephrines, overnight 1 mg dexamethasone suppression, and aldosterone-to-renin ratio where appropriate.³
Imaging. Dedicated CT or MRI of the adrenal glands, sometimes with additional functional imaging in selected cases.
Medical optimisation. Control of blood pressure, glucose and potassium before the operation. For phaeochromocytoma, alpha-blockade is started several weeks in advance.⁶
Pre-admission assessment. Routine bloods, ECG, and anaesthetic review. Current medications are reviewed; blood thinners and some diabetes medications are often paused around surgery.

The day of surgery

Adrenalectomy is performed under general anaesthesia and typically takes 2 to 3 hours, depending on tumour size and side. For robotic or laparoscopic surgery, small keyhole incisions are used. For an open operation, a single longer incision is made in the upper abdomen or flank.

For phaeochromocytoma, invasive blood pressure monitoring is standard throughout the operation and in the recovery period.

In hospital

Hospital stay: 1 to 2 nights for most minimally invasive cases; longer if an open approach is used or if post-operative blood pressure or cortisol management needs observation.
Pain relief: simple oral analgesia and a short course of stronger medication if needed; epidural analgesia is sometimes used for open surgery.
Mobilisation: up and walking on the evening of surgery or the next morning.
Drains and catheters: a urinary catheter is used during and briefly after surgery; any drains placed are usually removed within 24 to 48 hours.

Returning home

Light activities: 1 to 2 weeks.
Normal activities: 2 to 3 weeks.
Return to work: 2 to 4 weeks, depending on the occupation; longer for physically demanding roles.
Driving: once able to perform an emergency stop comfortably and off opioid analgesia.
Wound care: keyhole wounds are typically dressed with waterproof strips; dissolving sutures are used internally.

Hormones after surgery

Because the glands make different hormones, what happens after surgery depends on the tumour removed:

After phaeochromocytoma: blood pressure usually improves quickly. Occasional hypotension on the first day is managed with fluids and brief vasoactive support. Annual biochemical follow-up is standard.⁶
After cortisol-producing adenoma: temporary steroid replacement is usually needed while the opposite gland recovers. Tapering is guided by early-morning cortisol testing and your endocrinologist.⁷
After aldosterone-producing adenoma: aldosterone and potassium normalise; blood pressure improves, sometimes resolves, and medication is reduced gradually.⁹
After bilateral adrenalectomy (uncommon): lifelong steroid and mineralocorticoid replacement is required, coordinated with your endocrinologist.

Follow-up

A follow-up appointment is usually arranged 2 to 6 weeks after surgery to review the wounds, pathology and hormone results. Longer-term follow-up is condition-specific - for example annual biochemical testing after phaeochromocytoma, or imaging surveillance for adrenocortical carcinoma - and is coordinated with your endocrinologist or oncologist.

These are general timelines. Your team will give you personalised advice based on the condition, approach and your recovery.

Frequently asked questions

How long is the operation?

Usually 2 to 3 hours of actual surgery, plus anaesthetic and recovery time.

Will I still make hormones after surgery?

Yes - one adrenal gland is enough for normal hormone production. After removal of a cortisol-producing tumour, temporary steroid replacement is given while the opposite gland recovers.

How big are the scars?

For robotic or laparoscopic surgery, typically 3 to 5 keyhole incisions of 8 to 12 mm each. For single-port robotic surgery, one small incision. For open surgery, a single longer incision.

Will my blood pressure improve?

If your high blood pressure is driven by a functional tumour (phaeochromocytoma or Conn's syndrome), it usually improves substantially, and sometimes resolves. General essential hypertension is unaffected by adrenalectomy.

When can I fly?

Short domestic flights are usually fine after 1 to 2 weeks. Long-haul travel is usually delayed 3 to 4 weeks to reduce thromboembolic risk. Your team will give specific advice.