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What is Adrenalectomy?

Adrenalectomy refers to the surgical removal of an adrenal gland, located just in front of the kidney. This procedure is challenging for several reasons and usually only undertaken in a specialist setting by expert surgeons. 

Indications for adrenalectomy include the presence of a tumor. The surgery is high-risk due to difficulty accessing the tumor and the high percentage of cases that throw fatal blood clots in the 24 hours post-surgery. However, those dogs that do survive often have a reasonable long term outlook.

Adrenalectomy Procedure in Dogs

Adrenalectomy requires a full general anesthetic at a facility with the capability to provide rigorous monitoring of blood pressure, blood gases, ECG, and other vital parameters during anesthesia, plus an intensive care facility for the postoperative period. 

Depending on the type of adrenal tumor, the dog may receive medical therapy for two weeks prior to surgery in order to reduce the risk of complications such as throwing a life-threatening blood clot and to control high blood pressure. 

On the day of surgery, the dog should be fasting, and a premed injection is given which includes painkillers. After the dog is anesthetized, the surgeon usually makes on incision in the midline of the dog's belly, although an alternative technique involving an incision high on the right flank is preferred by some specialist when the right adrenal gland is to be removed. 

The surgeon uses retractors to hold the gut and liver aside, in order to gain access to the adrenal gland deep within the abdomen. The blood supply to the gland is tied off and the gland itself dissected away. 

The surgeon closes the laparotomy site and the patient is transferred to intensive care for close monitoring for 24 hours. 

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Efficacy of Adrenalectomy in Dogs

The act of removing the adrenal gland is an efficacious for getting rid of tumors in this location. The ultimate success depends on whether or not the patient survives to leave the hospital, how invasive the tumor was, and if malignant spread has already taken place or not. 

The complication rate is high (again depending on the type of tumor) with blood clots to the lungs being a major source of death peri and post-operatively. Other complications include pancreatitis, kidney failure, pneumonia, and heart rhythm irregularities. 

If surgery is not an option then the clinician can try to control the clinical signs by the use of medication, but this is only palliative and rarely satisfactory.

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Adrenalectomy Recovery in Dogs

The patient is at greatest risk during the operation itself and in the 24 hours post surgery. This is because rapid changes in hormone levels, plus the tendency for blood clots to form, can cause catastrophic, potentially fatal, problems that are difficult to control. 

As a rule of thumb, those that cope with this vital time and are able to go home, often do well provided that their cancer was no well advanced prior to surgery. It is essential to observe the regular guidelines during the recovery period, such as preventing the dog from licking the wound, rest, and avoiding stress. 

Medication started prior to surgery is gradually reduced and stopped, as indicated by regular blood pressure monitoring.

Skin sutures are usually removed at the 10 - 14 day point. 

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Cost of Adrenalectomy in Dogs

The dog requires an extensive work up prior to adrenalectomy which includes screening blood tests, specific diagnostic blood tests, radiographs and ultrasound. These alone will run into many hundreds of dollars. 

The surgical procedure and the intensive care needed in the postoperative period are costly, and an owner should expect to pay thousands of dollars or more. 

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Dog Adrenalectomy Considerations

Adrenalectomy is not a procedure to be taken on lightly. Whilst the procedure may be the dog's best option for recovery, the complication rate is high. It is therefore essential that each dog is thoroughly screened prior to going ahead, in order to determine that the cancer is not already far advanced. This would mean that the risks are unacceptable in view of the limited extra time the dog would gain should surgery go well. 

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Adrenalectomy Prevention in Dogs

It is not thought that environmental factors play a part in the development of adrenal gland tumors, thus it is difficult for the conscientious owner who wishes to reduce their pet's risk factors to do anything constructive. 

Adrenal tumors seem to be more prevalent in larger dogs than small; and there is an increased occurrence in female dogs over male. But other than that, whether or not a dog develops an adrenal tumor is largely a matter of fate. 

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Adrenalectomy Questions and Advice from Veterinary Professionals

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Morgan

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Coton de Tulear

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9 Years

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Serious severity

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Serious severity

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Our dog is 9 years old and was just diagnosed with adrenal cancer that has spread to her vena cava. She has been symptomatic for Cushings and is eating tons, drinking and peeing tons, and panting off and on. We were told if she doesn’t nave surgery she will not live more than a few months. We don’t know if we should have surgery done due to the spread. One vet said no, and we are seeing an oncologist this week for another opinion. Any thoughts?

Sept. 18, 2018

Morgan's Owner

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Ellie Mae (I put serious. Mod-)

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Mutt

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14 Years

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Moderate severity

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Moderate severity

Has Symptoms

Panting, Thirsty, Gimpy Leg, Gone

Hi. My lovely dog is 14. A mutt always 60 lbs. 6-8 months ago she got Cushing's Disease. I did notice and act fast. The tumor is adrenal and benign. Healthy all of her life with arthritis acquired,not life-altering last 3 years top. Generic Rimadyl was enough remedy. Back to the Cushings: (ps this upgraded spell-check is ruining me as I added some text. It will not allow for my own proficient self-edit to even stick. Sorry. Software is the boss of me)Vet was very non-surgery and all-Vetoryl. Her weight jumped to 66 lbs. Vetoryl 60 mg. Then 60mg twice a day. The same thing happened both times: Day 1: wiped. 2-6: It's working great. 7 on: Are we even on anything? Vet says "max dose". My dog started to fall, now has a shakey gimpy leg. (all in 3 weeks). She can't handle a whole walk at once (next 2-3 weeks). Now my dog has lost her appetite, is depressed as hell, "gave up" 2 days ago. Knows lots of vocab as trained since 5 weeks old. I repetitively explained: hang on..change..et al. Vet: She is "aging". B.S. Aging is progressive. Vets online use doses past weight of Vetoryl. Not limitless, about double plus a bit. Till symptoms are treated. "Surgery so complicated". Do Vet Surgeons not have basic robotic equipment plus laparascopy?, can Heparin be used at all during if removing? or will dog bleed out?, can Coumadin or something like it be used for post-Surgical prevention of clot development? I am not working but happen to be selling my owned house. Thus price is not in question. I have noticed dogs get old human meds some poopy some good (Acepromazine vs Rimadyl). Dogs had/have severe genetic storm phobia. I was swaddling 80 lb brother with cotton hospital blanket. Him: pogo-ing and sticking his tongue up my nose. Not his normal behavior. It might have been funny but not for 14 years and every single storm for the entire duration sometimes all night. Every New Years eve, 4th of July, dropped bag of ice..I loved Jethro so much. I realized how traumatized they were especially him. I valued the fact if any earthquake Tsunami Tornado or shifting of a tectonic plate beneath any place we were living occurred we would survive on high ground. Outside? Mutual of Omaha's Wild Kingdom. 80 lb darling looked like a black bear as he climbed trees and sawed through branches not twigs. After 2 molar removals- "He must masticate" Every Vet gave them the old nasty human no longer used antipsychotic acepromazine. It froze them but not their eyes which viewed beloved mommy as a traitor to be hated and snubbed for a while. Thunderjackets? Oh, they found them to be "nifty". Worthless. Tried exposure therapy (dogs are barking coming from other neighborhood - go home bad dogs!) They were into it until thunder struck then barking, yodeling, climbing trees, breaking molars, swinging from palm fronds... or drugged in time and stopped in motion like bugs trapped in amber with moving glaring betrayed eyes... The exposure therapy tried for hours with grilling steak in the backyard..nope. Walking them in it unafraid ....pure cruelty. Shutting every blackout window turning on every light in every room, every fan, television radio on loud to insulate and tried expensive sound-canceling headphones I somehow"McGuyver'ed" on them. Hours and hours and hours of distracting: played "get the light" via jumping on a track hidden (meaning everything in the house) with real home fried bacon hidden in everything "doggie sniff-n-seek" and even with "mommy-hand" what always happened? Jethro and Ellie Mae pogo-ing. Jethro somehow getting his massive tongue up one of my particularly not so large-sized nostrils over and over and over again. Or acepromazine and hatred. Please advice these 3: 1) I am in the greater Dallas Metroplex: Just because I think this "most dangerous adrenal surgery removal" SHOULD have been reduced in mortality by now, and I can't help but notice super-old human stuff in Veterinary is treated and priced as if cutting edge in Veterinary and am bothered by this, is there actually in every metro city somewhere a Vet with services on par with human available? Is it true I have to deeply chance my doggies death if I want the obvious optimal best: to remove the wretched tumor that is removable and causing all the trouble? If for a human I seriously doubt it would still be this dangerous as in high mortality rate. If I buy them a game of "operation" will it improve their skills NOT to hit the aortic vein or whatever is right next to it? Can I be allowed to scrub in and use my sterilized Tweezerman's with which I am quite proficient and will do it if they cannot do it without killing her? Do they have basic function with use of absolutely perfect robotic equipment which sounds more costly than it really is? This should be done laparoscopically only, shouldn't it? SHould I not run if someone suggests otherwise? I can't stand when any type of surgeon's office gets pissed if you ask about mortalities. What is the best way to ask that of the surgeon and anesthesiologist? And is the anesthesiologist always present and attending during surgery? Are you allowed to request this if you are willing to pay for it? How do you politely ask any of these things if you are a polite person and have nothing but respect for these specialists? I am pissy right now as we see my Vet so often and communicate so well and she has let it get to this. On the genetic Storm Phobia: If my darling feels better and breaks bad again or if I have another who truly suffers in the future what other options are there than acepromazine? No otc homeopathy snake oil placebo works. Everything has been tried. I tried my own anti-anxiety medication after thorough research that it was canine friendly. I imagine I also checked with the Vet. It's been a while. I titrated the dose per our difference in weight. Nothing. I tried my dose. A little bit. I stopped there. It did appear a horse-sized dose would be needed. I have worked in pharmaceuticals previously. If a drug was canine OK and vet approved for such use as the antidepressant mirtazapine which would induce a heavy sleepiness immediately but need more time for a beneficial antidepressant (so perfect) might that work? Or if using an antipsychotic at least try a newer atypical one if OK like Zyprexa (olanzapine) which would bring the sleep on and desire to eat the contents of an entire site of a chain pizza restaurant? An actual sleeping pill? Sorry so long. A profound "ThankYou".Condition you ask later? One category did not work. Moderate is too casual for how badly she is doing and how quickly she is getting worse. Serious sounds like I would have taken her to a 24 hour Vet tonight. I reach out to you and my Vet and another tonight. I call every Surgical specialist I can find as soon as I get up and see if at the least my vet can get her on is a somewhat efficacious dose of Vetoryl starting tomorrow even if moving forward with surgery, I won't know what to think if she still claims she won't budge on the dose for now a 66 lb dog based purely on safety after over 8 hours of reading every other Vet online go at least somewhat over weight with Vetoryl to treat symptoms... I do trust and like this vet as much as I can. The day Jethro died she did see him and said nothing other than the usual. I have not had dogs before and I blame myself.

Aug. 15, 2018

Ellie Mae (I put serious. Mod-)'s Owner


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Dr. Michele K. DVM

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1611 Recommendations

I'm not completely sure of your actual question, but I believe it is regarding the adrenalectomy? If the tumor is adrenal, and benign, she may be able to have the tumor removed, but that is a specialty surgery, and you would most likely want a board certified surgeon to perform the surgery. If you are in the Dallas area, you should have access to specialty surgeons that your veterinarian can refer to.

Aug. 15, 2018

Thank you. I did go into a few questions and it got disorganized. Sorry. Sticking to "Adrenalectomy". It appears that "Laparascopic Surgery" or "Robotic-Assisted Surgery" are 2 options rather than what, cutting big openings and through a lot of muscles, correct? In humans, I do believe only these options are used. In research and use reports, the Robot-Assisted has proven to have an advantage in less blood loss and in exact surgical cuts. Cost can be vastly different unless the facility regularly uses the Robotic Assistance device and at one point the price goes down and there is not a massive difference. My Question: I want the robotic-assisted surgery for my dog. Can you direct me where to find it? If she is a candidate, based on bloodwork and what else? Since this disease can be taken OUT by removing the TUMOR am I wrong for wanting it OUT? If you have knowledge that in the medical community of USA modern techniques for humans are also available to canines if you are willing to pay, can you please inform me? Tell me if every major city has just a place? Or if it is one or two centers in the country? Ot if any local Surgery Vet who does not use even laparoscopy should not be questioned at all, and this "difficult surgery" because of it's positioning near a major was it aortic? and clotting? should be assumed "it's a dog, don't ask questions?" Since clots are deadly, yet so common, do or can they give the dog immediatelly post surgically some more modern version of some Coumadin-like drug? Or should the dog have a shot of Heparin? How close after surgery (as in hours) are blood thinners (great for clots) not a danger post-surgery that could bleed the patient out? And get in the way of necessary clotting?

Aug. 16, 2018

Ellie Mae (I put serious. Mod-)'s Owner

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Bear

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Labrador Retriever mix

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11 Years

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Mild severity

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Mild severity

Has Symptoms

Seizures

is getting this surgery too risky for my dog? Reading about the complications and risks it has scares me. But Bear is having seizures that are becoming more frequent from every 3-4 months to almost monthly now. they located a tumor with an ultrasound on his right adrenal gland and they said they can remove it. He also got a cat scan, and they are fairly certain it is non cancerous but in order for a biopsy they need to cut into him regardless. The complications look risky but we all want bear to stop having seizures. What do you recommend?

July 16, 2018

Bear's Owner

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3320 Recommendations

Every surgery (even a simple castration or spay) has the potential to have complications, however when we (as Veterinarians) recommend surgery or any other treatment (medications have side effects etc…) we always weigh up the risk:benefit balance before making a recommendation to an owner. If your Veterinarian feels that Bear is fit for the surgery and will come through it better then I would follow their guidance; also think about the value in knowing the histopathology results of the adrenal mass. Regards Dr Callum Turner DVM

July 17, 2018

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Mill

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Mixed

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10 Years

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Fair severity

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Fair severity

Has Symptoms

Panting
Panting Drinking Large Amounts Of W

Mill was scheduled for surgery but was aborted due to low BP. Maybe reactions to anesthesia. Will this condition affect possible future surgery. Will this increase mortality rate chances. She show nho ill effects from the adrenal tumor, no Cushing decease. Is this surgery more of a risk?

April 18, 2018

Mill's Owner

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3320 Recommendations

Low blood pressure is always a concern during surgery and should be corrected or managed before or during surgery; if the blood pressure dropped before surgery it was wise to abort surgery so that the cause may be determined and managed. Once the blood pressure issues are under control your Veterinarian would be able to advise you on the risks of surgery. Regards Dr Callum Turner DVM

April 19, 2018

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Cola

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Mix

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10 Years

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Mild severity

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Mild severity

Has Symptoms

Frequent Uti

My dogs left adrenal gland was 12 mm on an ultrasound 6 mo. ago, a second ultrasound done it now : left is 15 mm and the right is 3mm. they want to remove the left adrenal gland. She is 10 years old. No MRI or CT scan has been done. what do you feel should be done. I know the surgery is very risky.

April 2, 2018

Cola's Owner

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Dr. Michele K. DVM

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1611 Recommendations

Without knowing more of the reasoning behind the testing, and the possible surgery for Cola, I unfortunately cannot comment on whether you should have the surgery done. Has it been determined that Cola has adrenal-dependent Cushings disease, or is there another reason? Since I cannot see her, and know no details of her history, it would be best to have a frank conversation with your veterinarian about risks and benefits of the surgery.

April 2, 2018

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Beamer

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Golden Retriever

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7 Years

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Moderate severity

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Moderate severity

Has Symptoms

Hair Loss

My 7-year-old Golden had his adrenal gland removed 3 months ago due to a tumor. He recovered well. However, this month he had major hair loss all over. Are the two things related?

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Una

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Rat Terrier

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8 Years

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Mild severity

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pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Mild severity

Has Symptoms

Frequent Urination
Hair Loss
Appetite Increased
Anxiousness
Easily Bruised
Think And Flaky Skin

My rat terrier Una (~8yo) was diagnosed with Cushings in February of 2019. I had noticed more frequent peeing and excess drinking of water but figured it was just her getting older. At her yearly exam in Nov 2018, I was considering a full dental cleaning (requiring anesthesia) so my vet did blood tests to make sure she could tolerate the anesthesia. Her liver values came back elevated so we put her on Denamarin (to treat liver disease) for few months and rechecked. Her levels continued to increase. Her appetite increased as well and she had hairless and frail skin. Since we assumed it wasnt liver disease (because the meds didnt work), we proceeded with an abdominal ultrasound.The results of the ultrasound were not necessarily indicative of an adrenal tumor as the size difference between glands was <0.5mm. The radiologist and my primary vet suggested that it may be Cushings and likely pituitary-dependent. Following the ultrasound we did the ACTH stimulation test and found that she was positive for Cushings. Because the ultrasound didnt conclusively show a mass, we assumed pituitary-dependent and proceed to treat with trilostane (Feb 2019). She had ACTH stimulation tests at 7days, 1 month, and 3 months. She was still symptomatic so we increased the dosage. It seemed to reduce her symptoms for a week or so but then she got worse again. My vet did not want to increase the dosage anymore because the ACTH stimulation results came back in the normal range. We tried switching half doses twice a day but didnt see any change. (Approx Sept 2019 by now). Since the meds weren't working as well, we decided to do an additional abdominal ultrasound to see if anything had changed...and it had. One adrenal gland had increased from ~7mm to 15mm (indicating a mass) and the other shrunk from ~7mm to 5mm. So the diagnosis changed to adrenal dependent Cushings for which surgery was the prescribed next step. While the surgery is extremely risky (and expensive >$6000 in Chicago), I considered that she was getting worse and her quality of life would degrade quickly without the surgery and that all the ultrasounds indicated that the mass had not spread or invaded other parts so removal would be on the "easier" side of the spectrum. I took a leap of faith and scheduled the surgery. She took meds for blood pressure management for 10days prior to the surgery (I forgot to mention that she had a <30sec seizure in July and one the week before surgery in Oct--but surgeon did not think the seizure would impact surgery). She had the surgery on Wednesday and was in the ICU for 24hrs after surgery and then general recovery until ~48hrs after surgery. I got her back today and she is currently sleeping beside me. She is still on meds and moves slowly but so far all her tests have showed stable values and blood pressure so we expect that she will recover well. (Because she was a smaller dog 15lbs, we did an open procedure instead of laparoscopic since the operating region was so small and the cost was ~1500 different, so she has a 6in incision down the middle of her soft belly.)

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Huanhuan - happy in Chinese

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Shihpoo

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11 Years

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Mild severity

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Mild severity

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I lost my beloved little boy, Huanhuan, two weeks ago, after adrenalectomy. He was an 11 year old Shih Tzu/Poodle mix, playful and energetic, and appeared healthy. He drank and peed excessively but no accidents. His liver enzyme was found high, which led to an MRI, which led to the discovery of an adrenal gland tumor that had invaded the blood vessel. MRI and lung x-ray didn't show spread so I decided to do the surgery to give him the chance to live out his life span. He was put on medication for one week prior to the surgery to regulate his blood pressure. The surgery went well and the surgeon was initially optimistic about releasing him the next day after surgery. Two hours later, they called me telling me he had stopped breathing. I am devastated over losing him. Had I knew the high risk, I would have been more hesitate to commit to the surgery. But what would be hid chance without the surgery? Would his chance be better if he had taken two weeks of the medication before surgery instead of one? Let me thank the two doctors who had provided many helpful answers. I wish I had discovered this site earlier.

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