Restoring peace: Why salvaging the adrenal gland makes sense
BY AMBER SMITH
On top of each kidney sits an adrenal gland, which produces hormones a person cannot live without.
A variety of different tumors can develop in an adrenal gland. The tumor‘s location, size and function influences how it should be treated. When a tumor needs to be removed, many doctors recommend taking out the entire adrenal gland.
Not so fast, says Gennady Bratslavsky, MD, who leads the department of urology at Upstate. Removal of the adrenal gland – called an adrenalectomy -- is not always the best option. If one gland is removed, and then problems develop in the other, patients are subject to a lifelong reliance on hormone medications.
Bratslavsky says removing just a portion of the gland containing the tumor is a valid option for patients with a type of hereditary tumor called pheochromocytoma, since the likelihood of developing tumors in the other gland is high with this condition. In a partial adrenalectomy, the healthy portion of the gland is left behind to continue functioning.
A study he co-authored for the American Urological Association‘s Urology Practice journal in November found that 80 percent of patients with hereditary pheochromocytoma developed tumors in both adrenal glands. That‘s the same month that Upstate hosted an international conference on the condition.
Erica Searles of Pompey stumbled upon that conference. With a recent diagnosis of pheochromocytoma, and a surgeon in Rochester prepared to remove one of her adrenal glands, she was doing some online research. She‘s glad she learned of Bratslavsky‘s less invasive option.
Searles had struggled for a year with symptoms including severe headaches, heart palpitations, back pain, excessive sweating, anxiety, depression and a feeling of doom. She ended up hospitalized at the age of 44 with heart failure, triggered by the excess adrenalin in her system, before doctors discovered a tumor in an adrenal gland.
It was located in the center of the gland, presenting a surgical challenge because it was just behind the large vein carrying blood into the heart. Bratslavsky operated in a minimally invasive manner using robotic assistance, and Searles went home from the hospital within 48 hours. Imaging scans show a healthy-looking gland, with no hint of the tumor that used to exist within. Bratslavsky says Searles is able to live a normal life.
She says she feels fabulous. She sleeps through the night, and she hasn‘t had a headache since her surgery in September. It has been life changing. “I just feel at peace,” she say, “and I have my life back.”
What‘s so bad about a benign tumor?
Most tumors arising in an adrenal gland are not cancerous, but they still cause problems for the patient.
“Benign does not mean harmless,” says Bratslavsky.
“Being benign means that the tumor has not spread, yet. These tumors can still be very active hormonally, meaning that they will produce lots of substances that can very negatively affect somebody‘s blood pressure, heart function, salt balance, sugar balance, weight, bone density and vision.”
This article appears in the spring 2016 issue of Upstate Health magazine. Hear an interview about partial adrenalectomy with Bratslavsky and Searles.