Adrenal Surgery, Questions to Ask

In this document, you’ll find suggested questions to ask when your dog has an adrenal tumor and you’re considering surgery. These questions were originally written by a dog owner (Trish), whose dog (Flynn) successfully underwent an adrenalectomy.

Part I is for the initial stages, when an adrenal tumor has been identified and you are considering if surgery is an option for your dog.

Part II lists questions for you, the owner, to ask yourself.

Part III is for when surgery has been decided upon. The suggested questions might help when you are discussing the surgery with your surgeon.

Part IV is questions to ask regarding post-surgical care.

Part I - Questions to ask your veterinarian when considering whether surgery is an option for your dog’s adrenal tumor:

1. What type of tumor do you suspect? Is the tumor functional (secreting hormones) or non-functional (not secreting hormones)?

2. Is the tumor benign or malignant?

3. Is surgery going to be of any benefit, in terms of extending my dog’s lifespan?

4. What is the prognosis if my dog is treated medically (i.e. with Cushing’s medications) versus the prognosis if surgery is conducted?

5. If I do not proceed with surgery, how long might it be before the tumor starts adversely affecting my dog’s quality of life?

6. Does the benefit of potentially risky surgery outweigh my dog’s current quality of life?

7. Are there any other health problems that could impact on a positive surgical outcome (for example, if the dog has heart, blood pressure, liver, kidney, or lung conditions)?

8. If the tumor is malignant, is there any sign that it has spread to other organs?

9. Has the tumor invaded blood vessels, such as the vena cava?

Note: imaging (preferably CT scan) should be done to check whether the tumor has invaded the vena cava or other blood vessels. Surgery is more high risk when the tumor is invasive.

10. Surgeon recommendations – would he/she do it for their own dog?

Part II. Questions to ask yourself:

1. Psychological impact: it is important to understand this is risky surgery. Sadly, current data indicates that 1 in 5 dogs do not make it. Can you accept your dog dying during surgery or in the postoperative recovery period? It’s important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.

2. Financially – can you afford it? Find out the estimate of costs.

3. If your dog collapses (e.g. his or her heart stops either during his surgery or afterwards), what emergency measures should be undertaken? Do you want your dog to have CPR? How far are you willing to go for your dog to be saved in such circumstances?

Part III. If surgery has been recommended as treatment for your dog’s adrenal tumor, here are a few suggested questions to ask your surgeon:

1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?

2. Please explain to me how you will do the surgery. Which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is there close supervision?

3. Will there be a specialist anesthetist available for the surgery?

4. If it hasn’t been done, do we need a CT scan/MRI to look at the tumor more closely and check for invasion into the vena cava or any other tumor spread?

5. What are the risks associated with this surgery? Potential risks to consider include:

• Bleeding (including trauma to blood vessels or other organs during surgery)

• clots

• Blood pressure or heart problems such as arrhythmias

• pancreatitis

• pneumonia

• kidney failure

• infection

• gastrointestinal problems

• anesthetic risks

• adrenal insufficiency or electrolyte abnormalities

• death (unfortunately, you have to ask about that risk too)

6. If we proceed with surgery, does my dog need pre-op treatment with Cushing’s meds, antihypertensive (if high blood pressure is a problem), phenoxybenzamine (recommended prior to surgery for dogs with pheochromocytoma), anticoagulants, or anything else?

8. What would you do if you found anything else during the surgery, such as nodules in other organs? Would you remove them? And what are the risks associated when doing additional abdominal surgery together with adrenalectomy?

9. How long will the surgery take, and when will you contact me afterwards?

Part IV. Questions to ask regarding post-surgical care:

1. When can I visit after surgery?

2. How long is my dog expected to stay in the hospital? How will you manage pain?

3. Does the hospital have 24/7 onsite veterinary and nursing care? Are emergency medications and fluids immediately available, if needed?

4. What monitoring will be needed (e.g. heart monitoring, oxygen levels) in the postoperative period?

5. What is the plan to reduce clot risk after surgery? Will anticoagulants be used, if needed?

6. How will adrenal function be assessed, after surgery? How will you determine if the remaining adrenal gland is functioning normally?

7. What is the plan if adrenal insufficiency (low cortisol) develops? Will my dog need to be on steroids following surgery and for how long?

8. Will I receive a written medication plan for hospital stay and discharge?

9. If there are problems when I take him home, who do I contact? Hopefully the surgical team, until all is stable.

NOTE: after surgery, the veterinarian should conduct an ACTH stimulation test to check whether the remaining adrenal gland is functioning normally. Months or years of cortisol overproduction from the tumor on the removed gland can sometimes cause the normal gland to stop producing cortisol of its own. If the ACTH test shows cortisol is low, the dog will need to take steroid medication until the remaining gland functions normally again, which can take up to six months or longer. It’s essential for the steroid to be given daily, in order to prevent severe and life-threatening cortisol deficiency.