Mount Sinai Health System has a rich history of caring for patients with adrenal disorders. Because of their complex nature, adrenal gland disorders require a host of disciplines to maximize the care of the patient. The Adrenal Center at Mount Sinai brings all of these experts together as one multidisciplinary team to focus on all aspects of care for each patient. Using a team approach, our Endocrinologists, Endocrine Surgeons, Cardiologists, Radiologists, Interventional Radiologists, Neurosurgeons, Nuclear Medicine Physicians, and Geneticists provide a comprehensive evaluation and treatment plan for these complex diseases.
Our surgeons offer innovative minimally invasive approaches to adrenal surgery, including both laparoscopic transabdominal and retroperitoneal approaches to adrenalectomy, single incision laparoscopic adrenalectomy, adrenal sparing surgery, and adrenal autotransplantation. All of these procedures are performed in our state-of-art minimally invasive operating suites at Mount Sinai, affording patients improved cosmetic results, shorter hospitalization, and quicker recovery.
What are the Adrenal Glands?
There are two adrenal glands, each sitting on top of the kidneys. They produce a host of hormones, including cortisol, aldosterone, and the sex steroids estrogen and testosterone. Cortisol helps the body to respond to stress, while aldosterone controls the balance of electrolytes, including sodium and potassium in the body. The adrenal glands also produce catecholamines called epinephrine and norepinephrine. Together these hormones contribute to the "flight or fight" response to rigorous activity and stress. These glands are redundant organs, meaning that the removal of one gland does not interfere with normal production and function of hormones from the remaining gland.
Disorders of the Adrenal Glands
Disorders of the adrenal glands are often the result of over production of the various hormones described above. Medications can sometimes control the excess hormone release, but most often surgery is the only cure.
These tumors produce too much catecholamines resulting in dangerously high blood pressure, which can often lead to stroke, heart attacks, and even death if left untreated. Removal of these tumors can be life saving and prevent devastating complications. Although they can be difficult to diagnose, patients often present with flushing, palpitations, and high blood pressure. These tumors can have malignant potential and patients require lifelong monitoring once diagnoses and treated.
These tumors produce too much aldosterone, often resulting in high blood pressure. Patients are usually on several medications with increasing doses to control their blood pressure. Patients are frequently found to have low potassium because aldosterone directly affects our salt and water balance. As a result, patients can complain of muscle cramps and weakness. These tumors are benign and once removed, can result in significant improvement in blood pressure. These tumors can be small and often adrenal venous sampling is required to help determine the side of the aldosteronoma.
Cushing's syndrome is an excess production of cortisol, the body's primary intrinsic steroid. This can result in a host of problems. Prolong exposure to cortisol can result in weight gain, acne, thinning hair, and easy bruising. Patients can even suffer from diabetes, increased susceptibility to infection, and brittle bones. Over production of cortisol can be associated with both benign and malignant conditions of the adrenal gland.
Patients are often found to have incidental growths on their adrenal glands from imaging studies done for other reasons. These incidentalomas are most often found on CT and MRI. Most of these growths have no clinical significance and are truly incidental. However, it is important that both overproduction of hormones and the possibility of malignancy are excluded. Surgery is only performed if they are found to be producing excess hormone or if they reach a certain size, often 4cm or greater.
Cancer of the adrenal gland is uncommon. They can produce a variety of hormones and often result in the rapid onset of symptoms. Surgery is often the only option for treatment and possible cure. These tumors can be large at the time of diagnosis and require open surgery for removal.
Adrenal Cancer Treatment
Most adrenal tumors can be removed through a minimally invasive surgery which minimizes scarring. We offer a wide variety of approaches which are tailored to the individual needs of the patient in order maximize patient outcomes. These techniques include:
- Laparoscopic transabdominal approach where small incisions are made in the abdomen to access the adrenal glands.
- Laparoscopic retroperitoneal approach where small incisions are made on the back to gain access to the adrenals
- Single incision laparoscopic surgery (SILS) where a single incision is made at the belly button to perform the surgery
The hormones produced by the adrenal gland are essential to normal function, but because the adrenal glands are redundant organs, patients can function with one gland. However, some conditions may require removal of both adrenal glands. We offer adrenal sparing surgery to patients who require removal of both glands. For patients who do not meet criteria for adrenal sparing surgery, we offer adrenal autotransplantation in the hopes of avoiding lifelong medication.
Adrenal Center Faculty
Cardiology and Hypertension
Lawerence Krakoff, MD
Alice C. Levine, MD
Cardiology and Vascular Services
Jeffery W. Olin, MD
Pam Unger, MD
Lale Kostakoglu, MD
Fax: 212-202-4713 or 212-202-4995
The Garlock Division of General Surgery
5 East 98th Street
3rd Floor (Mail Box 1259)
New York, NY 10029
1470 Madison Ave at 101st Street
3rd Floor (Mail Box 1259)
New York, NY 10029
More about the Adrenal Surgery
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