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Adrenal gland removal with the kidney | CION Cancer Clinics
The adrenal gland sits on top of the kidney inside the same envelope of fat. It is removed with the kidney only when the tumour is close to it, has grown into it, or the scan shows the gland is abnormal. For most people having a nephrectomy today it is left in place, and one healthy gland does the whole job. This page explains when it is taken, how that is decided, and what it means for you. 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 would the adrenal gland be removed with the kidney?
- Four situations where the surgeon takes the adrenal too
- Where the adrenal question gets answered
- Words about the adrenal you may see
- Living with one adrenal, and what this page cannot tell you
- Four things families ask about the adrenal gland
- Common questions about adrenal removal with the kidney
The short answer
Why would the adrenal gland be removed with the kidney?
The adrenal gland is a small, triangular gland that sits on top of each kidney, inside the same envelope of fat. It is removed with the kidney only when the tumour is close to it, has grown into it, or the scan shows something abnormal in it. For most people having a nephrectomy today, the adrenal is left where it is.
Why it used to be routine
For many years a radical nephrectomy meant removing the kidney, its fat and the adrenal gland together, whatever the tumour looked like. Better scans changed that. A CT or MRI now shows the adrenal clearly, and studies found that when it looks normal, it is very rarely involved. So surgeons now take it only when there is a reason to.
What the gland does
It makes hormones that control blood pressure, salt balance, the body's response to stress and, in part, blood sugar. You have two, and one healthy gland does the whole job. That is why losing one with the kidney usually changes nothing you can feel.
This page cannot tell you whether your adrenal will be removed. Your surgeon decides that from your scan, and sometimes only once they can see it in theatre.The reasons
Four situations where the surgeon takes the adrenal too
Each is about where the tumour sits or what the gland looks like, not about the size of the operation.
The tumour is at the upper pole
A tumour in the top of the kidney sits right against the gland. Removing the gland gives a clean margin of healthy tissue around the tumour, which is the point of the operation.
The scan shows the gland is abnormal
An enlarged adrenal, or a lump inside it, on the CT or MRI. It may be tumour that has reached the gland, or a separate growth. Either way, leaving it behind is not sensible.
Worth asking
- Does my scan report mention the adrenal?
- Is the plan to keep it or take it?
The tumour is very large
A big tumour can push against and distort the gland so that the surgeon cannot separate the two safely. Taking both together is cleaner and reduces bleeding.
It looks involved during the operation
Sometimes the scan looked clear but the gland feels hard or stuck to the tumour once the surgeon is inside. The consent form usually covers this, so the decision can be made there and then.
Ask your surgeon to say plainly whether the adrenal is on the consent form and why.Not sure whether this applies to you?
Ask an oncologistHow it is decided
Where the adrenal question gets answered
-
The scan report
The radiologist describes the adrenal on the same side as the tumour. "Adrenal normal" or "no adrenal lesion" usually means it will be left. Anything else is discussed further.
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The tumour board
Surgical, medical and radiation oncologists look at the scans together. If the gland looks doubtful, they may ask for hormone blood tests or a further scan before deciding.
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The consent conversation
Your surgeon tells you whether the plan is to keep or remove the gland, and whether that could change in theatre. This is the moment to ask what removing it would mean for you.
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The pathology report
If the gland was removed, the laboratory reports whether it held any tumour. That answer, not the removal itself, is what matters for what happens next.
On your report
Words about the adrenal you may see
- Ipsilateral adrenal
- The gland on the same side as the kidney tumour. The other one is the contralateral adrenal.
- Adrenal-sparing
- A nephrectomy where the gland was deliberately left in place. This is now the usual plan when the scan is clear.
- Adrenal involvement
- Tumour found inside the gland on the pathology report. It changes the stage written on the report and is discussed at the tumour board.
- Cortisol
- The main stress hormone the adrenal makes. Blood tests for it are sometimes done before surgery if the gland looks abnormal.
- Adrenal insufficiency
- When the body cannot make enough of these hormones. It happens only if both glands are gone or the remaining one is not working, and it is treated with tablets.
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Did you know
The adrenal gland sits inside the same fatty envelope as the kidney, so in the old style of operation it came out without a separate cut. Leaving it now takes a little more care from the surgeon, not less, and is done because the evidence showed it was safe to.
Being straight with you
Living with one adrenal, and what this page cannot tell you
If one gland is removed and the other is healthy, you should not need hormone tablets. The remaining gland takes over within days, and most people never notice the difference. Your team will not usually test the other gland unless there is a reason to doubt it.
When it is more complicated
It matters more if the other adrenal has already been removed, if it has a growth of its own, or if you have been on long-term steroid tablets for another condition, because those can quieten both glands. In those situations the team may plan steroid cover around the operation and check hormone levels afterwards. Tell your surgeon about any steroid use, including inhalers and creams used for a long time.
Who removal does not suit
Someone whose other adrenal is already absent or damaged may be advised to keep this one even with a tumour nearby, because the cost of losing both is a life on replacement tablets. That is a balance your team weighs with you, and it is a fair question to ask.
This page cannot say whether your gland held tumour. Only the pathology report can, and your team will go through it with you.Commonly believed
Four things families ask about the adrenal gland
"They took the adrenal, so the cancer must have spread."
Not necessarily. It is often removed because the tumour sat close to it, to give a clear margin, and the pathology report then finds the gland was normal. Wait for the report before drawing any conclusion.
"Without an adrenal I will need steroids for life."
Only if both glands are gone or the remaining one does not work. With one healthy gland left, no replacement is needed. Your team will tell you clearly if you are one of the few who do need tablets.
"It is safer to take it out anyway, just in case."
Studies found that removing a normal-looking gland does not help, and it takes away a spare that you may need later in life. Surgeons now keep it unless there is a reason not to.
"Losing the adrenal will change my blood pressure for good."
The other gland makes the same hormones. Blood pressure changes after a nephrectomy are more often about the kidney than the adrenal, and your doctor will review your tablets at follow-up either way.
Questions we are asked
Common questions about adrenal removal with the kidney
Will I know before the operation whether it is being removed?
Usually, yes. The scan tells the surgeon most of what they need, and the plan is explained at the consent conversation. What they will also say is whether the plan could change in theatre if the gland looks involved. Ask them to write on the consent form what has been agreed.
Does taking the adrenal make the operation longer or riskier?
Slightly longer, because there are extra small blood vessels to seal near the gland. The added risk is small in the hands of a surgeon who does this regularly. The bigger risks of the operation come from the kidney's own vessels, not from the gland.
Will I need hormone tests afterwards?
Not routinely if the other gland is healthy. Tests are done if both glands are affected, if you have used steroid tablets for a long time, or if you feel unusually weak, dizzy or sick in the weeks after surgery. Tell your team about those symptoms rather than waiting for a follow-up date.
What if the adrenal has its own separate growth?
Many adrenal lumps found on a scan are harmless and make no hormones. Some make too much of one hormone and need blood tests before surgery so the anaesthetist can prepare. Your team will say which kind yours appears to be and whether it changes the plan.
Can the adrenal be kept during a partial nephrectomy?
Almost always. A partial nephrectomy removes only the tumour and a rim of kidney, and the gland is not disturbed unless the tumour sits directly against it at the upper pole. If the surgeon plans to take it during a partial, ask why.
Will removing it change my weight, mood or energy?
With one healthy gland remaining, no. Tiredness in the weeks after surgery is from the operation itself and settles with recovery. If tiredness, dizziness on standing or salt cravings persist, mention them, because they are the signs your team would check hormone levels for.
I am on steroid tablets for asthma. Does that matter?
Yes, tell your surgeon and anaesthetist. Long use of steroid tablets can quieten both adrenal glands, so the team may give extra steroid around the operation to cover the stress of surgery. They set the plan; do not stop or change your tablets on your own.
Is the adrenal checked in the pathology report?
Yes, if it was removed. The report says whether any tumour was found in it. That finding is part of how the cancer is staged, and the tumour board uses it, along with the rest of the report, to decide whether any further treatment or closer follow-up is advised.
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Sources
- American Cancer Society — Surgery for Kidney Cancer
- Cancer Research UK — Surgery for kidney cancer
- NHS — Addison's disease
- National Cancer Institute — Renal Cell Cancer Treatment (PDQ) - Patient Version
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
What Happens in Theatre During a NephrectomyThe whole operation, stage by stageLymph Node Dissection During NephrectomyThe other extra step sometimes added to a nephrectomyBlood Pressure After Kidney RemovalWhy pressure changes are usually about the kidney, not the glandThe Pathology Report After SurgeryWhere the adrenal finding is written and what it meansMedicines Around Cancer SurgeryWhy steroid use must be declared before the operation
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Not sure what your scan says about the adrenal?
Send us the CT or MRI report or call the helpline. A surgical oncologist will tell you what the wording means and what to ask your surgeon. One helpline serves every CION centre.