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Blood pressure swings during adrenal surgery | CION Cancer Clinics
Blood pressure swings during adrenal surgery because the gland being removed makes the hormones that control it. Handling an adrenaline-producing tumour sends the pressure up; sealing its vein lets it fall. The swings are expected, planned for and managed beat by beat by the anaesthetist. This page explains which tumours cause them, what happens in theatre, and what the first night looks like. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why does blood pressure swing during adrenal surgery?
- What the anaesthetist does about it, step by step
- Before the vein is sealed, and after
- Which adrenal tumours cause which swings?
- Four things families ask us, and what is actually true
- What happens on the first night, and what this page cannot tell you
- Common questions about blood pressure during adrenal surgery
The short answer
Why does blood pressure swing during adrenal surgery?
Blood pressure swings during adrenal surgery because the gland being removed makes hormones that control it. When the surgeon touches an adrenaline-producing tumour, adrenaline pours into the blood and the pressure shoots up. The moment the gland's vein is sealed, that supply stops and the pressure can fall just as fast.
Which operations this applies to
The big swings belong to phaeochromocytoma, the adrenaline-producing tumour. Tumours that make cortisol or aldosterone cause smaller, slower changes, and a gland removed for a lump that makes no hormone usually behaves like any other keyhole operation. If your report does not mention phaeochromocytoma or raised metanephrines, most of this page is about a risk your team has already ruled out.
Why it is manageable
The swings are expected, so the team plans for them. Weeks of blocking tablets beforehand blunt the body's response. On the day, the anaesthetist reads your pressure beat by beat through a line in the wrist artery and has fast-acting drugs drawn up to push the pressure down or hold it up within seconds. The surgeon and anaesthetist talk to each other throughout, and the surgeon slows down or pauses when asked.
This is why the choice of anaesthetist matters as much as the choice of surgeon for this operation. Ask who will be in the room.In the theatre
What the anaesthetist does about it, step by step
Lines before anything else
Besides the usual drip, a thin line goes into the artery at your wrist so pressure is displayed continuously. For a phaeochromocytoma a central line in the neck is often added, so strong drugs can be given straight into a large vein.
A gentle start
Going to sleep and having the breathing tube placed can itself set off a surge. The anaesthetist deepens the anaesthetic and uses pressure-lowering drugs before those moments, not after.
Watching while the surgeon works
Every time the tumour is moved, the pressure trace is watched for a spike. Fast, short-acting drugs such as nitroprusside, phentolamine, nicardipine or magnesium bring it down within seconds. If a spike will not settle, the surgeon stops handling the gland until it does.
The vein is sealed
The surgeon tells the anaesthetist before clipping the adrenal vein. The pressure-lowering drugs are stopped, fluids are run in, and a pressure-raising drug such as noradrenaline is often started to carry you through the drop.
Waking and handover
You wake with the arterial line still in, so the recovery and high-dependency nurses can keep the same close watch through the first night.
Not sure whether this applies to you?
Ask an oncologistTwo halves of one operation
Before the vein is sealed, and after
Before the adrenal vein is sealed
After the adrenal vein is sealed
Pressure tends to spike each time the tumour is touched
Pressure tends to fall as the adrenaline supply stops
Pressure-lowering drugs are running or ready
Fluids and pressure-raising drugs take over
The surgeon works slowly and pauses on request
The surgeon checks for bleeding and closes
Heart rhythm is the other thing being watched
Blood sugar is the other thing being watched
By tumour type
Which adrenal tumours cause which swings?
Your hormone results tell the team which pattern to expect. Ask which of these is yours.
Adrenaline: phaeochromocytoma
The large, fast swings described on this page. High during handling, low after the vein is sealed. Needs blocking tablets beforehand and an anaesthetist who manages these regularly.
Also watched for
- Irregular heart rhythms
- Low blood sugar after removal
Cortisol: Cushing's syndrome
Pressure is often high going in, but the change is gradual. The bigger issue is afterwards, when cortisol drops and the other gland has not woken up. Steroid cover is given from the day of surgery.
Aldosterone: Conn's syndrome
Pressure usually behaves during surgery. Potassium is corrected beforehand and rechecked after. Many people need fewer blood pressure tablets in the months that follow, adjusted step by step by the doctor.
No hormone at all
A lump that makes nothing, removed because of its size or appearance, gives the anaesthetist an ordinary keyhole operation to manage. The standard monitoring is used.
Every lump still gets hormone tests first, because a quiet-looking tumour can be active.Leave a number, we will call you
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Commonly believed
Four things families ask us, and what is actually true
"Her pressure went up in theatre, so something went wrong."
For an adrenaline-producing tumour a rise during handling is the expected event, and the whole set-up exists to manage it. What matters is that it was brought down quickly. Ask the team how the operation went overall, not whether the trace was flat.
"He is on a drip to hold his pressure up, so he must be very sick."
A pressure-raising drip through the first night is common after a phaeochromocytoma, because the body has to relearn life without a flood of adrenaline. It is usually weaned off within a day or so. It is part of the plan, not a complication.
"Keyhole surgery avoids all of this."
The route does not change the hormones. Keyhole surgery means smaller cuts and a quicker recovery, but the tumour still releases adrenaline when it is handled, and the same preparation and monitoring are needed.
"Once the tumour is out, the blood pressure problem is over."
Often it improves a great deal, but not always completely, especially if the pressure was high for years or for other reasons. Home readings and follow-up visits decide which tablets, if any, continue. Do not stop any of them on your own.
Afterwards, and being straight with you
What happens on the first night, and what this page cannot tell you
After a phaeochromocytoma, the first night is usually spent in a high-dependency bed with the arterial line still in. Pressure, pulse and blood sugar are checked often, fluids are adjusted, and any pressure-raising drip is weaned as your body settles. Family members seeing the monitors and drips for the first time often assume the worst. Ask the nurse to explain what each one is for.
The sugar problem nobody warns you about
Adrenaline keeps blood sugar up. Once it is gone, sugar can fall, sometimes sharply, in the hours after surgery. This is why sugar is checked so often on the first night, and why you may be given glucose through the drip before you are eating properly. People with diabetes need their medicines re-checked before going home.
What this page cannot tell you
It cannot tell you how your own pressure will behave, how long you will need a drip, or which tablets you will go home on. Those depend on your tumour, your preparation and your heart and kidneys. Ask the anaesthetist at the pre-operative visit what they expect in your case, and who will be managing the first night.
If you take blood pressure tablets already, bring the full list to the pre-operative visit. Which ones continue on the morning of surgery is decided by the anaesthetist, not by you.Questions we are asked
Common questions about blood pressure during adrenal surgery
Can the blood pressure surge cause a stroke or heart attack?
An unprepared, unmonitored surge can, which is the whole reason for the blocking tablets and the arterial line. With proper preparation and an anaesthetist who manages these tumours, the spikes are caught within seconds and brought down. Serious events are uncommon in prepared patients, but the risk is never zero, and your team should discuss it with you openly.
What is an arterial line, and does it hurt?
A thin tube placed in the artery at the wrist, usually after a small injection of local anaesthetic or once you are asleep. It shows your pressure continuously rather than every few minutes from a cuff. It stays in through the first night and is removed on the ward with a few minutes of firm pressure.
Why does the surgeon stop in the middle of the operation?
Because the anaesthetist has asked for a pause while a pressure spike is brought down. Handling the tumour releases adrenaline, and a few seconds of stillness lets the fast-acting drugs work. Pausing is normal in this operation and is a sign the two are working together, not that anything has gone wrong.
Why did the pressure drop after the tumour came out?
The tumour had been keeping the blood vessels tightly squeezed for months or years. When its vein is sealed the adrenaline stops, the vessels relax, and the pressure falls. Extra fluids and a short course of a pressure-raising drip carry you through while the body adjusts. The salt and fluid loading beforehand softens this drop.
Will I be in the ICU?
After a phaeochromocytoma, usually a high-dependency or ICU bed for the first night, planned in advance so the close watch on pressure and sugar continues. After removal of a gland that made cortisol, aldosterone or nothing at all, many people go back to the ordinary ward. Ask which is planned for you.
Does this happen with keyhole surgery too?
Yes. The hormones do not know which route the surgeon took. Keyhole surgery brings smaller wounds and a quicker recovery, and some surgeons find the gas pressure in the abdomen itself nudges the pressure up, so the same lines, drugs and preparation are used whether the operation is keyhole or open.
My father has a weak heart. Is this operation still possible?
Sometimes, with extra planning. A heart that has been strained by years of adrenaline may need a cardiologist's assessment, a heart scan and a longer period of preparation before the team is satisfied. For some people the risks outweigh the benefit and medicines are chosen instead. That judgement is made for each person individually.
Will my blood pressure be normal afterwards?
For many people it improves considerably, and some come off tablets altogether over the following months. Others still need some medicine, especially if the pressure was high for years or there are other causes. Home readings and follow-up decide it. Any change to your tablets is made by the doctor, never on your own.
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Sources
- NHS — Phaeochromocytoma
- National Cancer Institute — Pheochromocytoma and Paraganglioma Treatment (PDQ) - Patient Version
- Cancer.Net (ASCO) — Adrenal Gland Tumor: Types of Treatment
- NHS — Cushing's syndrome
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Phaeochromocytoma: Why Preparation Is CriticalThe weeks of tablets that make the swings manageableAdrenalectomy: What the Operation InvolvesThe whole operation, from admission to going homeAnaesthesia for Cancer SurgeryWhat the anaesthetist checks and does for any operationICU and the First Days After SurgeryWhat the monitors, drips and lines are forSteroid Replacement After Adrenal SurgeryWhy some people need tablets once the gland is gone
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