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Endocrine surgery · UK

Adrenalectomy, by a specialist endocrine surgeon.

Laparoscopic, posterior retroperitoneoscopic or robotic removal of one or both adrenal glands for Conn\'s, Cushing\'s, phaeochromocytoma, virilising tumours and adrenal masses - by a BAETS-registered surgeon in a high-volume unit, with endocrinology and HDU backup.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why patients choose us

  • 01

    A specialist endocrine surgeon, in a high-volume unit

    Not a general laparoscopist. A named BAETS-registered endocrine surgeon operating in a unit that runs regular adrenal lists with endocrinology and anaesthesia backup.

  • 02

    The right approach for the tumour

    Laparoscopic transperitoneal, posterior retroperitoneoscopic or robotic. Open for very large or invasive tumours. The choice is driven by the imaging and the biochemistry, not the surgeon's habit.

  • 03

    Independent, and free

    We are paid by no clinic, so the recommendation is impartial and costs you nothing.

Indicative pricing

What a private adrenalectomy costs in the UK.

Indicative ranges across our partner units. Send the imaging and biochemistry and we quote firm figures across two or three options.

Procedure Indicative range
Laparoscopic transperitoneal adrenalectomy £14,000–£24,000
Posterior retroperitoneoscopic adrenalectomy (PRA) £18,000–£28,000
Robotic adrenalectomy £22,000–£32,000
Open adrenalectomy (large tumour or ACC) £22,000–£38,000
Adrenal vein sampling (AVS) for Conn's £3,500–£5,500
Endocrine workup package (bloods and imaging review) £800–£1,600

Prices vary by unit, by which surgeon does the case, by tumour size, by the need for AVS or MIBG imaging, and by the length of HDU stay for phaeochromocytoma or Cushing\'s cases.

The journey

From referral to cure - what happens, in order.

One team from first message to endocrine follow-up - including any AVS, workup and the steroid taper.

  1. 01

    Before

    You send us imaging and bloods

    A short, confidential form. The CT or MRI report, the biochemistry to date (aldosterone-renin ratio, metanephrines, dexamethasone suppression, DHEAS) and any endocrine clinic letters.

  2. 02

    Before

    We come back with a recommendation

    Within one working day: a matched endocrine surgeon, a matched endocrinologist, whether adrenal vein sampling is needed first, and an indicative price. An honest read either way.

  3. 03

    Before

    Workup and preparation

    Any missing tests are booked (AVS for Conn's, MIBG for phaeochromocytoma). Alpha blockade is started for phaeochromocytoma, potassium and spironolactone reviewed for Conn's, hydrocortisone planned for Cushing's.

  4. 04

    On the day

    Admission and anaesthesia

    Same-day admission, arterial line and large-bore access. General anaesthetic with an endocrine-experienced anaesthetist. Antibiotics and DVT prophylaxis at induction.

  5. 05

    On the day

    The adrenalectomy itself

    1.5 to 3 hours. Three to four ports for laparoscopic or robotic; a small posterior incision for retroperitoneoscopic. The gland is dissected off the vena cava or aorta, the adrenal vein clipped, the specimen bagged and retrieved.

  6. 06

    On the day

    Overnight or short stay

    Most patients go home the next day. Bilateral cases, phaeochromocytoma and open surgery stay 2 to 4 nights with HDU observation.

  7. 07

    After

    Histology and endocrine follow-up

    Histology in 10 to 14 days. Repeat biochemistry at 6 weeks to confirm cure. Steroid replacement is tapered by the endocrinologist over weeks to months if the contralateral gland was suppressed.

Indications

When adrenalectomy is the right step.

The syndromes and masses that lead to adrenal surgery, and the imaging red flags that push the case straight to an MDT.

  • Conn's syndrome (aldosteronoma)

    Primary hyperaldosteronism from a unilateral adenoma - resistant hypertension and hypokalaemia. AVS lateralises before surgery if bilateral hyperplasia is possible.

  • Cushing's syndrome (cortisol-secreting adenoma)

    Unilateral cortisol-secreting adenoma driving weight gain, diabetes, hypertension and skin fragility. Adrenalectomy is curative; steroid cover is essential.

  • Phaeochromocytoma

    Catecholamine-secreting tumour of the adrenal medulla. Full alpha and beta blockade before surgery. See the dedicated phaeochromocytoma pathway page.

  • Virilising or feminising tumour

    Androgen or oestrogen-secreting adenoma - hirsutism, virilisation or gynaecomastia with raised DHEAS or testosterone. Rare and often warrants malignancy workup.

  • Non-functional adenoma >4 cm or growing

    Adrenal incidentaloma above 4 cm, or growing more than 5 mm per year, warrants resection for malignancy risk even without hormone excess.

  • Adrenocortical carcinoma (ACC)

    Primary adrenal cancer, often large and heterogeneous on CT. Open R0 resection by an ACC-experienced surgeon with oncology input.

  • Isolated adrenal metastasis

    Solitary metastatic deposit from lung, renal or melanoma primaries, in a patient otherwise controlled - resection can extend disease-free survival.

  • Red flag: heterogeneous mass >6 cm on CT

    Irregular margins, high unenhanced HU, delayed washout or local invasion - refer for MDT and PET-CT rather than a straightforward laparoscopic list.

Procedure options

Four surgical approaches, plus medical options.

The right technique depends on the size of the tumour, whether it is functioning, and whether malignancy is suspected. We match the surgeon to the operation.

  • Laparoscopic transperitoneal

    The gold standard for most functional tumours under 6 cm. Three or four ports, lateral decubitus, excellent view of the adrenal vein. Day case or overnight for many patients.

  • Posterior retroperitoneoscopic (PRA)

    The Walz technique. Prone position, direct retroperitoneal access, no bowel handling, quicker recovery. Ideal for bilateral or smaller tumours in specialist hands.

  • Robotic adrenalectomy

    Wristed instruments and 3D vision. Outcomes comparable to laparoscopic; ergonomic benefit for the surgeon on right-sided or obese cases.

  • Open adrenalectomy

    Reserved for tumours over 8 cm, suspected ACC, local invasion or IVC involvement. A subcostal or thoracoabdominal incision gives full oncological control.

  • Adrenal vein sampling (AVS)

    A radiology procedure done before Conn's surgery. A catheter samples aldosterone from each adrenal vein to prove which side is producing hormone.

  • Medical management with an MRA

    For bilateral Conn's hyperplasia or patients unfit for surgery, a mineralocorticoid receptor antagonist (spironolactone or eplerenone) controls blood pressure and potassium without an operation.

  • Cortical-sparing adrenalectomy

    For bilateral disease (hereditary phaeochromocytoma), leaving a rim of adrenal cortex avoids lifelong steroid replacement. Higher recurrence risk, careful case selection.

  • MDT referral (ACC)

    Any suspected adrenocortical carcinoma is discussed at an ACC MDT before surgery, with mitotane and oncology involvement planned upfront.

Our vetted UK network

A small panel of endocrine surgeons, we picked them.

BAETS-registered endocrine surgeons with high adrenal case volumes, working alongside endocrinologists and interventional radiology. Introductions are made privately once we understand your case.

  • BAETS-registered endocrine surgeons with high adrenal case volumes

  • Endocrinology-led biochemical workup and steroid tapering

  • Interventional radiology for adrenal vein sampling on site

  • HDU-level postoperative care and an endocrine-experienced anaesthetist

Safety and recovery

What to expect afterwards - honestly.

Modern adrenalectomy in experienced hands has low morbidity. The specifics worth planning are the perioperative preparation, the intraoperative BP window for phaeo, and the steroid taper afterwards.

  • Bleeding from the adrenal vein

    The right adrenal vein is short and drains directly into the IVC. Meticulous dissection matters. Transfusion is uncommon in experienced hands.

  • Intraoperative BP crises (phaeo)

    Tumour manipulation can release catecholamines. Full alpha blockade for two weeks, beta blockade added after, and generous volume expansion prevent most crises.

  • Postoperative adrenal insufficiency

    After removal of a cortisol-secreting adenoma the contralateral gland is suppressed. Hydrocortisone replacement is started day one and tapered over weeks to months.

  • Hypoaldosteronism

    Rare after unilateral surgery. In bilateral adrenalectomy, lifelong fludrocortisone and hydrocortisone replacement is required, with a steroid emergency card.

  • Wound and port-site complications

    Infection, seroma or port-site hernia in a small percentage. Weight, diabetes and steroid exposure raise the risk.

  • DVT and pulmonary embolism

    Cushing's patients are hypercoagulable. Compression stockings, calf pumps and extended chemical prophylaxis after discharge for high-risk cases.

  • Back to work: 2 to 3 weeks

    Laparoscopic and retroperitoneoscopic patients return to desk work in 2 to 3 weeks. Exercise and lifting build up over 4 to 6 weeks.

  • Open surgery recovery: 6 to 8 weeks

    A subcostal incision needs longer for wound healing and to return to full activity. Physiotherapy and structured mobilisation help.

  • Red flags after discharge

    Fever, severe abdominal or flank pain, dizziness on standing, vomiting or a swollen calf - call the unit or attend A&E the same day.

Reading your operation note

Your adrenalectomy report in four parts. Read the last one first.

Whichever approach was used, the report the surgeon and pathologist send keeps to the same shape.

  1. 01 Diagnosis

    Which syndrome, which side

    Which hormone was overproduced, the biochemical peak values, and the imaging that localised the tumour - CT washout characteristics, MRI signal, MIBG or PET uptake.

  2. 02 Operation

    Approach, findings and blood loss

    Laparoscopic, PRA, robotic or open. Tumour size, capsule status, any adhesions to vena cava, spleen or liver, and the estimated blood loss.

  3. 03 Histology

    Weiss score or Ki-67 for cortical tumours

    For cortical lesions, the Weiss score decides benign versus malignant. For phaeochromocytoma, the PASS or GAPP score. Margins are always reported.

  4. 04 Follow-up

    Cure confirmation and steroid taper

    Read this first: when repeat biochemistry is done, the initial hydrocortisone dose and how it is tapered, and the endocrinology and oncology follow-up plan.

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Frequently asked

Everything we get asked about adrenalectomy.

  • What is an adrenalectomy?

    Adrenalectomy is the surgical removal of one or both adrenal glands. Most operations are done laparoscopically or with the posterior retroperitoneoscopic technique through small incisions, taking 1.5 to 3 hours under general anaesthetic. Open surgery is reserved for large tumours, suspected adrenocortical carcinoma or local invasion.

  • How do I know I need one?

    The two triggers are a functioning tumour producing too much hormone (Conn's aldosteronoma, Cushing's cortisol-secreting adenoma, phaeochromocytoma or a virilising tumour) and a non-functional adrenal mass over 4 cm or growing more than 5 mm per year on surveillance imaging. Adrenocortical carcinoma and isolated adrenal metastases are additional indications.

  • What is adrenal vein sampling and do I need it?

    AVS is a radiology procedure in which a catheter samples aldosterone from each adrenal vein. It is the reference standard to lateralise Conn's syndrome before surgery, distinguishing a unilateral adenoma (which surgery cures) from bilateral hyperplasia (which is treated medically with a mineralocorticoid receptor antagonist). Most patients over 35 with Conn's have AVS before adrenalectomy.

  • How much does private adrenalectomy cost in the UK?

    Roughly £14,000 to £24,000 for laparoscopic transperitoneal, £18,000 to £28,000 for posterior retroperitoneoscopic, £22,000 to £32,000 for robotic, and £22,000 to £38,000 for open surgery on a large or malignant tumour. AVS adds £3,500 to £5,500. We come back with firm figures within one working day.

  • What are the results I can realistically expect?

    For Conn's, 60 to 80 percent of patients cure or substantially improve blood pressure and over 90 percent normalise potassium. Phaeochromocytoma is cured by resection. Cushing's achieves biochemical remission; steroid replacement is then tapered gradually. Adrenocortical carcinoma has a poorer outlook with 5-year survival around 30 to 40 percent and needs oncology input.

  • Where in London can this be done privately?

    Specialist private centres include the endocrine surgery unit at King's College Hospital Private, Guy's and St Thomas' Private, Imperial Private Healthcare at Charing Cross, and HCA The Wellington, alongside individual BAETS-registered endocrine surgeons across the capital. We match the surgeon and the unit to the biochemistry, tumour size and technique that fit your case.

Ready to move

Send the imaging and the bloods. We come back within a working day.

A named endocrine surgeon, a matched endocrinologist, and firm pricing across two or three options - all in one honest read.

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