Assessment at Gota OPD, Ahmedabad · Surgery at Apollo Hospital, Bhat, Gandhinagar
Most adrenal tumours never need an operation; the ones that do are the tumours that make hormones and the ones that might be cancer. Every adrenal lump is asked two questions, in this order: is it producing a hormone, and could it be malignant? The answers decide whether the lump is removed, watched for a set period, or simply left alone, and they also decide what has to be protected during and after the operation — blood pressure, the body’s own cortisol, and, in adrenal cancer, the chance of taking the tumour out whole.
Send your CT or MRI and any hormone reports ahead of your appointment, so the consultation starts with them already read · +91-63590-11009
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Urology Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Shah’s Gastro, Cancer & Robotic Surgery Centre. Trained at high-volume cancer units, fully qualified in surgical oncology, and 18 years of experience in cancer surgery. Rated 4.99 from 84 Google reviews at the Gota clinic and 5.0 from 33 at Apollo, Bhat.
The first question is whether the lump is making a hormone; the second is whether it could be cancer. Neither is skipped, and the hormone question comes first, because a hormone-making tumour can be dangerous at any size and changes how any later operation must be prepared.
The adrenal glands sit on top of each kidney. They make cortisol, which carries the body through stress and illness; aldosterone, which holds salt and sets blood pressure; and adrenaline-type hormones, which drive the pulse and blood pressure in a crisis. A tumour in the gland can overproduce any of these, or none of them.
Most adrenal lumps are found by chance, on a CT scan done for a stone, back pain or a check-up. Some announce themselves: blood pressure that will not come down on several medicines or starts young; low potassium; spells of headache, pounding heartbeat and sweating that feel like panic attacks; rapid weight gain with thin skin, easy bruising and new diabetes; or rapidly appearing excess hair and other signs of too much male or female hormone. That last pattern points towards adrenal cancer and is investigated urgently, not rescanned in six months.
So every adrenal lump has the same blood and urine tests, whatever its size:
A plain, non-contrast CT scan measures how dense the lump is. A smooth, even lump that measures ten Hounsfield units or less is a benign adenoma — and under the 2023 European guideline it needs no further scans at all, whatever its size, provided the hormone tests are normal.
That rule changed practice. A large but clearly benign adenoma used to be scanned year after year; it no longer is, and you are told plainly when you can stop worrying about it.
A lump that is denser, uneven, irregular at its edge, contains dead tissue or calcium, or is growing, is called indeterminate. It needs a second look — a washout CT, a chemical-shift MRI or a PET-CT — and a low threshold for removal. Size still counts as a warning sign, rising beyond about four centimetres and more so beyond six, but size never overrides a clean density result, and a small lump with worrying features is not reassured by being small.
Two groups are offered surgery sooner for an indeterminate lump: people under forty, and women who are pregnant, because in both the chance of malignancy is higher and years of scanning suit them least. A lump that is watched and then grows by more than a fifth of its width and by at least five millimetres is removed — both conditions, not either.
A needle biopsy of an adrenal lump is almost never the right first step. If the lump is a phaeochromocytoma, the needle can trigger a dangerous surge in blood pressure; if it is adrenal cancer, the needle can spill tumour cells along its track. A suspicious lump is removed whole instead.
A biopsy has a narrow place — when a spread from a cancer elsewhere, or a lymphoma, is suspected and the answer will change treatment — and even then only after a phaeochromocytoma has been ruled out by blood or urine tests. If you have been told you need an adrenal biopsy before these tests have been done, bring that question to the consultation.
| Type | What usually happens | Follow-up afterwards |
|---|---|---|
| Non-functioning adenoma, low density and even | No operation | None needed, whatever the size; you are discharged with clear warning signs |
| Adenoma making a little cortisol (mild autonomous cortisol secretion) | Blood pressure, sugar, cholesterol and bones are treated; the adrenal is removed only in selected people | Yearly check of blood pressure, HbA1c, lipids and bone density |
| Aldosterone-producing adenoma, confirmed on one side | Keyhole adrenalectomy, or tablets that block aldosterone | Blood pressure and potassium; blood pressure often improves, though not always fully |
| Cortisol-producing adenoma (Cushing’s) | Adrenalectomy with steroid cover before, during and after | Steroid tablets tapered slowly while the other gland wakes up |
| Phaeochromocytoma or paraganglioma | Weeks of blocking tablets, then adrenalectomy | Lifelong yearly metanephrine tests; genetic testing offered to you and your family |
| Adrenocortical carcinoma (adrenal cancer) | Open operation to remove the tumour whole, sometimes with tablets afterwards | Scans and hormone markers every three months at first, then at longer intervals for years |
In adrenal surgery the trade is not between cancer and continence, as it is lower in the urinary tract. It is between removing a tumour completely and keeping three things: the small keyhole incision, the neighbouring organs, and the body’s own steroid supply. Each can often be kept — and each has a point past which keeping it costs cancer control.
The keyhole incision. For benign hormone-making tumours and small lumps, laparoscopic adrenalectomy — through the abdomen or from the back — is the standard: fewer complications and a shorter hospital stay. Robotic adrenalectomy is a reasonable equivalent in benign disease. But when adrenal cancer is suspected, the operation is open. The tumour must come out in one piece with its capsule intact; if the capsule tears during a keyhole dissection, cancer cells seed the abdomen and a removable cancer becomes a spread one. A suspected cancer is not attempted through keyholes because it “looks manageable”, and a keyhole operation is converted to open without hesitation when the tumour is larger or more stuck than the scan suggested.
The neighbouring organs. The right adrenal lies against the liver and the inferior vena cava; the left against the spleen, the tail of the pancreas and the kidney. A benign tumour almost always comes away cleanly. A large or invasive cancer may need part of the pancreas, the spleen or the kidney removed with it to get it out whole. This is discussed before surgery, so a decision about your kidney is never made without your knowledge.
The steroid supply. Steroid cover is planned for two situations, and the plan for each is made before the operation:
A phaeochromocytoma releases bursts of adrenaline-type hormones. Before it is removed, the blood vessels must be relaxed with an alpha-blocker for at least one to two weeks, and only after that is a beta-blocker added, if the pulse is still fast. Alpha first, beta never first.
The order matters more than anything else on this page. A beta-blocker given first to someone with an unblocked phaeochromocytoma can cause a hypertensive crisis, fluid on the lungs and collapse. If you have a suspected phaeochromocytoma and have been started on a beta-blocker alone, that is corrected the same day, not at the next clinic visit.
Alongside the tablets you are asked to take more salt and plenty of fluids. Years of high adrenaline shrink the blood volume, and refilling it is what prevents the steep fall in blood pressure that follows once the tumour’s vein is tied. The tablets are working when blood pressure has settled, you feel slightly light-headed on standing and your nose feels a little blocked.
Many patients start to feel well on the tablets and stop them. That decision is what makes the operation dangerous, so the plan is simple: if the full course has not been taken, the operation is postponed. The theatre team confirms the blockade out loud before the operation begins. Even a phaeochromocytoma with normal blood pressure is blocked in this unit: the cost of blocking is some dizziness, and the cost of not blocking can be a life.
During the operation the adrenal vein is tied early where the anatomy allows, the tumour is handled as little as possible, and you spend at least a day in the ICU afterwards, with blood pressure and blood sugar watched hourly, because sugar can fall sharply once the tumour is gone.
Adrenocortical carcinoma is treated by a complete, open, en bloc removal with the capsule intact. What follows depends on the stage, the resection margin and the Ki-67 index — a laboratory measure of how fast the cancer cells are dividing — so all three must appear on the pathology report.
For a cancer at higher risk of returning — a higher stage, a high Ki-67, or a margin that is not clear — mitotane tablets are advised for at least two years. For lower-risk cancer, the ADIUVO trial published in 2023 found no benefit from mitotane, and it is not given. Older practice in India treated most patients after surgery; this unit follows the newer evidence.
Mitotane is a demanding treatment. It needs regular blood levels, causes nausea and other side effects, and shuts down the body’s own cortisol, so higher-than-usual steroid replacement is given throughout. Its supply in India is intermittent and blood-level testing is not widely available, so both are confirmed before a two-year course is started, and you are told that at the outset.
The evidence for adrenal cancer is thinner than for most cancers on this site. The adrenal cancer guideline dates from 2018 and the phaeochromocytoma guideline from 2014, and neither had been replaced at the last check. Where the advice is a judgement rather than a proven rule, Dr Swati Shah tells you so.
| Function | What to expect | How it is watched |
|---|---|---|
| Blood pressure | After a phaeochromocytoma, blood pressure is low for the first day and is supported in the ICU. After an aldosterone tumour it often improves, though some people still need a tablet | Readings at home and at each visit; metanephrines repeated two to six weeks after a phaeochromocytoma if blood pressure stays high |
| Cortisol | After a cortisol-making tumour, steroid tablets for many months; the other gland usually recovers over six to eighteen months, sometimes longer. After both glands are removed, steroids for life | Morning cortisol and Synacthen tests guide the taper under an endocrinologist |
| Blood sugar | Can fall sharply in the first hours after a phaeochromocytoma is removed | Hourly checks in the ICU on the first day |
| Salts and potassium | Potassium is corrected before an aldosterone tumour is removed; sodium and potassium are checked from the first day after any adrenalectomy | Blood tests on day one and at follow-up |
| Eating, walking, going home | Sips on the day of surgery, soft food the next day, walking three times a day from day one; home in about four to seven days once everything is stable | Discharge only when the criteria below are met |
| Cancer surveillance | Phaeochromocytoma: yearly blood or urine tests for life. Adrenal cancer: scans and hormone markers every three months for two years, then less often | Booked before you leave hospital |
If you will need steroid tablets after surgery, a few rules are not risks but certainties. They are taught to you and to a family member together, in your own language, with the emergency injection in your hands, and you say them back before you go home.
Low blood pressure, vomiting, abdominal pain or confusion at any time after adrenalectomy is treated as adrenal crisis, with hydrocortisone first and tests afterwards. A person on steroids who feels well is not a low-risk person: the most preventable death in adrenal surgery is a crisis in someone who skipped or failed to double their tablets during a fever.
Like any abdominal operation, adrenalectomy can bring bleeding that needs transfusion, wound infection, a clot in the legs or lungs, a heart event, a reaction to anaesthesia, conversion from keyhole to open surgery, or a return to theatre. Specific to the adrenal: injury to the spleen, pancreas, liver, kidney or bowel; a pancreatic leak after a left-sided operation; air around the lung; injury to the vena cava or kidney vessels; and, after open surgery, an incisional hernia. Phaeochromocytoma adds swings in blood pressure, low blood pressure needing ICU support, and low sugar. Adrenal cancer adds the possibility that the tumour proves more extensive than the scan showed, and that it can return even after complete removal. Your own figures for each are given at the consent discussion, separated by the type of operation, not published here as averages.
★★★★★
“My wife's adrenal tumour surgery was successfully done by Dr. Swati Shah. She is a highly skilled and experienced surgeon who explained everything clearly and made me feel comfortable throughout the treatment. After surgery, my recovery was smooth and I am absolutely fine now. Highly recommended for anyone looking for the best doctor for adrenal tumour surgery in Ahmedabad.”
Sharma Sharma, October 2025
★★★★★
“We are very thankful to Dr. Swati Shah for successfully operating on our relative for kidney cancer. From the first consultation to the surgery and follow-up, she was very supportive, caring, and explained everything clearly. Her expertise and confidence gave our family great reassurance during a difficult time. We are happy with the treatment and recovery. Highly recommended Dr. Swati Shah for her dedication and excellent care.”
Naween. Soni, Google review
★★★★★
“We are very thankful to Dr. Swati Shah for her excellent treatment and care for urinary bladder cancer. She explained the condition and treatment options clearly and made us feel confident throughout the treatment journey. Her expertise, dedication, and compassionate approach are truly appreciated. We are very happy with the care and support received. Highly recommended for anyone looking for an experienced cancer surgeon.”
A K, Google review
Adrenalectomy for phaeochromocytoma — a patient video from Dr Swati Shah’s channel (in Hindi).
What moves the estimate is the type of tumour, keyhole or open surgery, the number of days in ICU and on the ward, the room category, and whether a neighbouring organ has to be removed. Apollo Hospital, Bhat, is empanelled with most major insurers and cashless TPAs, and its insurance desk arranges pre-authorisation before admission.
Some costs sit outside the hospital bill and are planned for from the start: metanephrine tests, which are self-funded; the weeks of blocking tablets before a phaeochromocytoma operation; steroid tablets and the emergency injection kit; genetic testing where it is advised; and, for adrenal cancer, mitotane and its blood-level monitoring. Each is quoted when it is ordered, not discovered afterwards.
Discharge happens only when you are eating, walking on your own, comfortable on tablets, steady without blood pressure support and with normal sugar — and, if you will be on steroids, when you and a family member can state the daily dose, the sick-day doubling rule and when to use the injection, and have the alert card and injection in hand.
Usually not. An incidentaloma is simply a lump found by chance. If the hormone tests are normal and a plain CT shows a smooth, even lump of ten Hounsfield units or less, it is a benign adenoma and needs no operation and no further scans, whatever its size. An operation is considered only if it makes a hormone or looks suspicious.
Size is a warning sign, especially beyond about four to six centimetres, but it is not the deciding test. A large lump with a clearly benign density on CT needs no surgery, and a small lump with worrying features is not reassured by being small. The density, the edges, the hormone tests and any growth on a repeat scan decide.
For benign hormone-making tumours and small lumps, yes — laparoscopic adrenalectomy is the standard, and robotic surgery is a reasonable equivalent in benign disease. When adrenal cancer is suspected the operation is open, because the tumour has to come out whole with its capsule intact.
Only in two situations. If your tumour was making cortisol, you will need steroids for many months while the other gland recovers, usually six to eighteen months. If both glands are removed, you will need hydrocortisone and fludrocortisone every day for life. In either case you and a family member are taught the sick-day rules before you go home.
The alpha-blocker relaxes the blood vessels so that the tumour's hormone bursts cannot drive blood pressure dangerously high during surgery, and extra salt and fluids refill the blood volume. The course runs for at least one to two weeks. If it has not been completed, the operation is postponed — that rule protects you.
For phaeochromocytoma and paraganglioma, a meaningful share are hereditary, so genetic counselling and testing are offered. If a gene change is found, first-degree relatives are offered testing, and it decides their own lifelong check-ups as well as yours.
Consultation at Gota. Surgery at Apollo, Bhat, Gandhinagar.
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