ADRENALECTOMY

Data Base
A. General information
1. Surgical removal of one or both adrenal glands
2. Lifelong glucocorticoid replacement is necessary with bilateral adrenalectomy
3. Temporary glucocorticoid replacement, up to 2 years, is necessary for a unilateral adrenalectomy
4. Catecholamine levels drop as a result of surgery, which can result in cardiovascular collapse, hypotension, and shock, and
the client needs to be monitored closely
5. Hemorrhage can also occur owing to the high Vascularity of the adrenal glands
6. Indications
a. Tumors of adrenal cortex (Cushing’s syndrome, hyperaldosteronism) or medulla (pheochromocytoma)
b. Metastatic cancer of the breast or prostate

B. Nursing interventions: preoperative

1. Provide routine pre-op care
2. Monitor electrolytes and correct electrolyte imbalances
3. Assess for dysrhythmias
4. Monitor for hyperglycemia
5. Protect client from infections
6. Correct metabolic/cardiovascular problems
a. Pheochromocytoma: stabilize blood pressure
b. Cushing’s syndrome: treat hyperglycemia and protein deficits
c. Primary hyperaldosteronism: treat hypertension and hypokalemia
7. Administer glucocorticoid preparation on the morning of surgery as ordered to prevent acute adrenal insufficiency

C. Nursing interventions: postoperative

1. Provide routine post-op care
2. If the urinary output is less than 30 mL per hour, notify the physician, because this may be indicative of renal failure,
hemorrhage and impending shock
a. Monitor vital signs, I&O, daily weights, and electrolytes
b. Monitor for signs of shock and hemorrhage, particularly during first 24 to 48 hours
c. Administer IV therapy and vasopressors as ordered
3. Assess the dressing for drainage
4. Monitor for paralytic ileus, as manifested by abdominal distention and pain, nausea, vomiting, and diminished or absent
bowel sounds, because paralytic ileus can develop from internal bleeding
5. Prevent infections (suppression of immune system makes clients especially susceptible)
a. Encourage coughing and deep breathing to prevent respiratory infection
b. Use meticulous aseptic technique during dressing changes
6. Administer IV fluids, as prescribed, to maintain blood volume
7. Administer cortisone or hydrocortisone as ordered to maintain cortisol levels
8. Administer pain medication as prescribed, remembering that meperidine (Demerol) can cause hypotension
9. Provide general care for the client with abdominal surgery

D. Provide client teaching and discharge planning concerning

1. Instruct the client in the importance of glucocorticoid therapy following surgery
2. Self-administration of replacement hormones
a. Bilateral adrenalectomy: lifelong replacement of glucocorticoids and mineralocorticoids
b. Unilateral adrenalectomy: replacement therapy for 6-12 months until the remaining adrenal gland begins to
function normally
3. Signs and symptoms of adrenal insufficiency
4. Instruct the client regarding the need to wear a Medic-Alert bracelet
5. Importance of follow-up care

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