UAB is First in Alabama and Possibly the Southeast to Perform

By Laura Freeman

Overproduction of adrenal hormones can usually be addressed without the need to remove both glands. When it can’t, the situation becomes more difficult for both the patient and the surgical team.

“In most cases, we can stop the flood of cortisol, adrenalin and other hormones up-stream at the pituitary,” UAB surgeon Brenessa Lindeman, MD, MEHP said. “Tumors or other pituitary abnormalities may be increasing the flow of hormones that stimulate overproduction in the adrenals. Removing the tumor usually corrects the problem. But when it fails, or when pituitary surgery is too dangerous, it may be necessary to remove both adrenal glands.”

Adrenal hormones such as cortisol and adrenalin are survival mechanisms that gear the body up for a fight or flight response to deal with stress, fear or danger. However, an unrelenting excess of these hormones would be like living in a perpetual panic attack.

“We aren’t meant to be under stress all the time,” Lindeman said. “It can wear our bodies down. Excessive adrenal hormones can cause thinning of bones, wasting of muscles, high blood pressure, heart issues and many metabolic problems. It must be addressed.

“30 years ago, removing adrenal glands required big incisions. Laparoscopic surgery was an improvement, but patients were positioned on their side for access through the abdomen all the way through to the back. The distance and working around other organs wasn’t ideal. When both adrenals had to be removed, they couldn’t be accessed at the same time, so that meant two entirely separate surgeries. Patients were under anesthesia twice as long, and for some, especially more fragile patients, that could be a problem. It also meant surgical teams were working twice as long and fatigue tends to make precision more challenging.”

Lindeman learned the retroperitineoscopic technique during fellowship training at Brigham and Women’s Hospital in Boston. She brought the technique with her when she came to UAB in 2017.

“We position patients face down on their abdomen so we can go directly through the back,” she said. “It’s a shorter distance and allows two surgeons to work together at the same time. Access through the back also works better for single adrenalectomies. It’s a shorter distance, so there’s less pain than an abdominal approach, no risk of hernia and recovery is faster. Patients having a single gland removed can often go home the same day. 

“Only a handful of centers in the U.S. are performing two-surgeon bilateral adrenalectomies. UAB is the first in Alabama and likely the first in the southeast. I’m passing on the technique by training our residents in surgical fellowships. Both Jessica Sazendin, MD, and Andrea Gillis, MD, have worked with me in the second surgical position to perform the procedure.”

Another thing Lindeman likes about the surgery is that it’s more collaborative.

“If one of us comes across something unusual and wants a consult, all we have to do is speak with the surgeon across the table,” she said. “Our patients have done well. I just caution them not to lift anything heavy for a while. We keep the bilateral patients an extra day or so to closely monitor their hormone levels as they transition to hormone replacement. They will need to continue to replace hormones for the rest of their lives, much the same as patients who have thyroid surgery.”

Healing usually progresses rapidly after surgery. Patients are free of the excess stress hormones that had been keeping them on edge and have been wearing away at their bodies. They can relax and enjoy getting back to normal life again.