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Surgical removal of the adrenal glands may be necessary for a number of conditions (see Table 11.12). Large tumours, which may be malignant, are removed via a
flank incision following removal of a rib. The diaphragm, pleura and peritoneum are left intact wherever possible. A posterior approach through the bed of the 11th or 12 rib is more difficult, but has a lower morbidity. Lifelong corticosteroid (both glucocorticoid and mineralocorticoid with hydrocortisone and fludocortisone) replacement therapy is needed following bilateral adrenalectomy. Laparoscopic adrenalectomy is increasingly being used.
Replacement is monitored by blood pressure measurement, serum electrolytes and patient well-being. Stress, infection and surgery may all increase corticosteroid requirements, and may precipitate an Addisonian crisis. Patients need to be advised of the signs and symptoms and management of such events.
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