Adrenalectomy (Latin root Ad "near/at" + renal "related to the kidneys" + Greek ‑ectomy “out-cutting”; sometimes written as ADX for the procedure or resulting state)[1][2] is the surgical removal of one (unilateral) or both (bilateral) adrenal glands.

[3] Minimally invasive techniques are increasingly the gold standard of care due to shorter length of stay in the hospital, lower blood loss, and similar complication rates.

[5] Most adrenal tumors are noncancerous (benign), often found incidentally as a mass via imaging such as CT scans, MRI, or ultrasound that were taken for other health workups (see incidentaloma).

In addition, American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons guidelines state minimally-invasive techniques should be avoided when there is a large tumor size (larger than 6 cm) due to difficulties in maneuvering around a large mass, and in adrenocortical carcinoma where there is a risk of not fully removing the cancerous tissue.

[3][7] However, at least one meta-analysis of 898 patients has found shorter length of stay, less blood loss, and no higher rates of complications even in large (>5 cm) tumors using minimally-invasive techniques.

[8][3] Traditionally, this has been through the laparoscopic transperitoneal approach (LTA) where the small cuts are made in the abdomen to reach the adrenal glands through the peritoneum from the front-side.

However, an alternative approach is possible called retroperitoneoscopic adrenalectomy (PRA), where the adrenal glands are reached through small cuts made in the back.

After adrenalectomy for a cortisol-producing adenoma, patients should be treated with exogenous glucocorticoids such as cortisone or hydrocortisone until the hypothalamic-pituitary-adrenal (HPA) axis has recovered.

Similarly, for patients who have undergone adrenalectomy for (subclinical) Cushing syndrome, perioperative glucocorticoid therapy and postoperative assessment of HPA axis recovery are necessary.

This requires lifetime treatment with the hormones produced by the removed adrenal glands, including glucocorticoids and mineralocorticoids (fludrocortisone).