What Is Adrenalectomy And Its Definition ...
The Iwo it adrenal glands are situated at the upper poles of the kidneys and tire relatively inaccessible should surgical excision be required. Each gland consists ()I' two components: the inner medulla and the outer cortex. Adrenaline and noradrenaline are secreted from the medulla ; they are secreted in excess by the benign tumour of the medulla, phaeochromocyIonia (('hapter 29, p. 299). Two of the many hormones secreted by the cortex rire essential for life.
They are aldosterone which conserves sodium by controlling the rate of loss in the urine, and hydrocortisone which has a vital functioo in maintaining the blood pressure. Without hydrocortisonethe patient dies from hypotensive shock (Addisonian crisis, p. 297). An excess of aldosterone (Conn's syndrome) or an excess of hydrocortisone (Cushing's syndrome) may result from hyperactivity of the whole cortex, from a benign hyperfunctioning tumour of the cortex, or rarely from carcinoma. Both glands may also be removed to alter the hormonal environment in cases of advanced breast carcinoma.
Operation
Adrenalectomy may be carried out through an abdominal incision or through a loin incision. As with all loin exposures, there is a danger of pneumothorax from damage to the pleura, and a careful watch for post-operative respiratory difficulty should be kept. The choice of incision is usually one of personal surgical preference. For bilateral adrenalectomy many prefer a single abdominal incision to two loin incisions.
Replacement therapy.
The essential adrenal hormones must be replaced regularly for life after bilateral adrenalectomy and replacement may be required tem¬porarily after a unilateral operation where suppression of the remaining gland has occurred. Hydrocortisone in suitable dosage is started before operation, and maintained by intravenous injection for several days after operation until the surgeon is sure that the patient can absorb oral medica¬tion, whereupon the treatment changes to drugs with a similar action to hydrocortisone but which can be taken by mouth. Hydrocortisone possesses some of the salt-retaining properties of aldosterone, but in certain cases it is necessary to prescribe another drug with specific electrolyte functions, .fludrocortisone. The nurse should appreciate that after adrenalectomy a patient is extremely reliant upon his adrenal replacement therapy. Patients are given cards to carry with them always, containing information about the drugs and dosage of their treatment.
In the early postoperative period the surgeon may find it difficult to diagnose whether a state of shock is 'hypovolaemic and due to internal reactionary haemorrhage, or else due to adrenal hormone deficiency. Accurate fluid balance charts, especially the volume, specific gravity and chloride concentration in the urine, may be a vital factor in the assessment.
Sepsis is predisposed to by an excess of adrenal cortical hormones, and such patients should have every possible precaution against sepsis both before (several baths with an antibacterial agent such as chlorhexidine in the water), during and after the operation. Infection of the wound is a common complication, and often rather silent in its onset.
The Iwo it adrenal glands are situated at the upper poles of the kidneys and tire relatively inaccessible should surgical excision be required. Each gland consists ()I' two components: the inner medulla and the outer cortex. Adrenaline and noradrenaline are secreted from the medulla ; they are secreted in excess by the benign tumour of the medulla, phaeochromocyIonia (('hapter 29, p. 299). Two of the many hormones secreted by the cortex rire essential for life.
They are aldosterone which conserves sodium by controlling the rate of loss in the urine, and hydrocortisone which has a vital functioo in maintaining the blood pressure. Without hydrocortisonethe patient dies from hypotensive shock (Addisonian crisis, p. 297). An excess of aldosterone (Conn's syndrome) or an excess of hydrocortisone (Cushing's syndrome) may result from hyperactivity of the whole cortex, from a benign hyperfunctioning tumour of the cortex, or rarely from carcinoma. Both glands may also be removed to alter the hormonal environment in cases of advanced breast carcinoma.
Operation
Adrenalectomy may be carried out through an abdominal incision or through a loin incision. As with all loin exposures, there is a danger of pneumothorax from damage to the pleura, and a careful watch for post-operative respiratory difficulty should be kept. The choice of incision is usually one of personal surgical preference. For bilateral adrenalectomy many prefer a single abdominal incision to two loin incisions.
Replacement therapy.
The essential adrenal hormones must be replaced regularly for life after bilateral adrenalectomy and replacement may be required tem¬porarily after a unilateral operation where suppression of the remaining gland has occurred. Hydrocortisone in suitable dosage is started before operation, and maintained by intravenous injection for several days after operation until the surgeon is sure that the patient can absorb oral medica¬tion, whereupon the treatment changes to drugs with a similar action to hydrocortisone but which can be taken by mouth. Hydrocortisone possesses some of the salt-retaining properties of aldosterone, but in certain cases it is necessary to prescribe another drug with specific electrolyte functions, .fludrocortisone. The nurse should appreciate that after adrenalectomy a patient is extremely reliant upon his adrenal replacement therapy. Patients are given cards to carry with them always, containing information about the drugs and dosage of their treatment.
In the early postoperative period the surgeon may find it difficult to diagnose whether a state of shock is 'hypovolaemic and due to internal reactionary haemorrhage, or else due to adrenal hormone deficiency. Accurate fluid balance charts, especially the volume, specific gravity and chloride concentration in the urine, may be a vital factor in the assessment.
Sepsis is predisposed to by an excess of adrenal cortical hormones, and such patients should have every possible precaution against sepsis both before (several baths with an antibacterial agent such as chlorhexidine in the water), during and after the operation. Infection of the wound is a common complication, and often rather silent in its onset.
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