When Is It Necessary to Remove an Adrenal Nodule and How Is the Surgery Performed?

Adrenal nodules, also called adrenal incidentalomas, are masses that are discovered by chance on imaging studies such as CT scans or MRIs performed for unrelated reasons. Although most of these nodules are benign and do not require treatment, some may represent a significant health risk and need urgent evaluation to determine whether surgery is necessary.

This article explains what an adrenal nodule is, when removal is recommended, and how surgery is performed to treat these tumors.

What Is an Adrenal Nodule?

The adrenal glands are two small organs located above each kidney. Their main function is to produce essential hormones such as cortisol, aldosterone, and adrenaline. These hormones regulate metabolism, blood pressure, stress response, and electrolyte balance.

An adrenal nodule is a mass or lesion that appears in these glands. It can be:

• Benign: such as a nonfunctional adenoma that does not produce hormones.

• Hormone-producing tumor: which generates excess hormones and causes symptoms.

• Malignant: in rare cases, an adrenal cancer.

Most adrenal nodules do not cause symptoms and are found accidentally on imaging studies performed for other reasons.

When Is Surgery Recommended?

The decision to remove an adrenal nodule depends on several factors that indicate potential health risks. These include the size of the nodule, its ability to produce hormones, imaging characteristics, and growth over time.

• Size of the Nodule

Size is one of the most important indicators when deciding on surgery. Nodules larger than 4 centimeters carry a higher risk of malignancy or causing problems, so their removal is generally recommended.

• Hormone-Producing Nodules

Some adrenal tumors produce excessive hormones, which can lead to serious symptoms. The most common types of hormone overproduction include:

• Aldosterone: causing hard-to-control high blood pressure and low potassium levels.

• Cortisol: causing Cushing’s syndrome, which presents with weight gain, muscle weakness, and skin changes.

• Catecholamines: as seen in pheochromocytoma, causing excessive sweating, palpitations, anxiety, and intense headaches.

When a nodule produces excess hormones, surgery is usually necessary to control symptoms and avoid complications.

Imaging Features Suggestive of Malignancy

Imaging characteristics that may suggest cancer risk include:

• Irregular or poorly defined borders

• High density on CT scan

• Rapid growth on follow-up imaging

If these features are present, surgery is recommended to remove the nodule and obtain a definitive diagnosis.

Growth Over Time

If an adrenal nodule increases in size on follow-up studies, this may indicate greater risk and justify surgery.

Symptoms of Hormone-Producing Tumors

Functional tumors may cause symptoms affecting quality of life and overall health, such as:

• High blood pressure that is difficult to control

• Unexplained weight gain, especially in the abdomen and face

• Excessive sweating and frequent palpitations

• Anxiety without clear cause

• Newly diagnosed or hard-to-control diabetes

• Persistent, intense headaches (especially with pheochromocytomas)

These symptoms should prompt hormonal and imaging studies to identify a functional tumor.

How Is Surgery Performed to Remove an Adrenal Nodule?

The standard surgical treatment for most adrenal tumors is laparoscopic or robotic adrenalectomy. These minimally invasive techniques offer several advantages:

• Small incisions that reduce postoperative pain

• Faster recovery compared to open surgery

• Lower risk of complications

• Laparoscopic Adrenalectomy

During surgery, the surgeon makes small incisions in the abdomen to insert a camera and surgical instruments. This provides visualization of the adrenal gland and allows removal of the nodule or the entire gland if necessary.

The procedure lasts 1 to 3 hours, depending on tumor size and complexity. Most patients can resume normal activities within a few weeks.

• Robotic Adrenalectomy

Robotic adrenalectomy is a minimally invasive technique used to remove an adrenal gland affected by benign, malignant, or functional hormone-producing tumors. Using the robotic system, the surgeon gains an enlarged 3D view and precise control of instruments, enabling fine movements in a small anatomical space.

This technology reduces surgical trauma, postoperative pain, and recovery time compared to traditional open surgery. Robotic adrenalectomy is especially beneficial for complex tumors or those located near delicate structures, offering greater safety and improved patient outcomes. It is a modern, safe, and highly effective approach for treating adrenal diseases.

Postoperative Care

After surgery, the medical team monitors hormone levels and blood pressure to ensure the body adjusts to the absence of the tumor or the gland. In some cases, temporary or permanent hormone therapy may be needed.

Cases Where Surgery Is Not Recommended

Not all adrenal nodules require surgery. For example:

• Nodules smaller than 4 cm without hormonal production

• Lesions that are stable in size with benign imaging features

• Patients with medical conditions that contraindicate surgery

In these cases, periodic follow-up with imaging and hormonal testing is recommended to detect any changes.

Conclusion

Adrenal nodules are common findings that, in most cases, do not pose an immediate threat. However, when size, hormone production, or imaging features suggest a risk, surgery is the best option to prevent complications and improve the patient’s health.

If you have been diagnosed with an adrenal nodule, consult an endocrine surgeon for a comprehensive evaluation. Early detection and appropriate treatment can make a significant difference in your prognosis and quality of life.