Froedtert & the Medical College of Wisconsin Endocrine  Surgery - Before and After Adrenal Surgery

Before Surgery

Before Your Clinic Visit:
Prior to your clinic visit, you may need to undergo a series of tests to complete the workup for your adrenal disease. This will include a CT scan as well as blood work. Additional studies may be ordered depending on your type of adrenal disease.

Before Surgery
Prior to having surgery, a series of general screening tests are done to make sure you are healthy for surgery. These are often conducted 1-2 weeks before the operation and may include blood work as well as a thorough history and physical exam. Depending on your history, you may also need an EKG, chest x-ray, and/or stress test. These tests evaluate your heart and lung function. They do not require a hospital stay. Depending on your age and health, you may see a high-risk anesthesiologist, your primary care doctor or the surgeon for these tests.

Prior to surgery, you may also meet with an endocrine nurse practitioner who will educate you about the operation and make sure all the appropriate testing has been completed.

Medication Guidelines

PLEASE ASK your doctor or surgeon BEFORE stopping or changing any of your medications.

Medication Guidelines Prior to Surgery:
Certain medications may need to be stopped before surgery. Please consult your surgeon or primary care physician before stopping any of your prescribed medications.

Cardiac medications (blood pressure medications): DO NOT take on the day of surgery:

• Benazepril (Lotensin)
• Bumetanide (Bumex)
• Candesartan (Atacand)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Eprosartan (Teveten)
• Fosinopril (Monopril)
• Furosemide (Lasix)
• Hydrochlorothiazide (HCTZ)
• Iosartan (Cozaar, Hyzaar)
• Irbesartan (Avapro)
• Lisinopril (Prinivil, Zestril)
• Metolazone (Zaroxolyn)
• Olmesartan (Benicar)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Spironolactone (Aldactone)
• Telmisartan (Micardis)
• Valsartan (Diovan)

Blood thinners: Please make sure you have discussed this with your physician or surgeon strong>before stopping these medications.

• Aspirin – Stop taking 7 days before surgery
• Coumadin – Stop taking 5 days before surgery
• Heparin – Must be held for 12 hours prior to surgery
• Antiplatelet agents (Plavix, clopidogrel, ticlopidine) – Please follow your surgeon or cardiologist’s recommendations.

Diabetes medications:
Insulin – Patient with insulin pumps:

• Continue your basal rate ONLY

Patients without insulin pumps:
On the morning of surgery:

• Hold short acting insulin
• Pre-mixed insulin (eg. 70/30): give 1/3 of usual dose
• Lantus: give usual dose

Oral diabetic medications: do not take the morning of surgery

• Metformin
• Glyburide
• Glipizide

Other prescription medications:

• MAO inhibitors – do not take the day of surgery
• Premarin – do not take on the day of surgery
• Viagra or similar drugs – do not take 24 hours before surgery

Over-the-counter medications:

• Aspirin – stop taking 7 days before surgery
• NSAIDS (ibuprofen, Aleve, naproxen, Celebrex) – stop taking 7 days before surgery
• Iron – do not take on the day of surgery
• Herbal supplements and Vitamin E-containing multivitamins – stop taking 7 days prior to surgery

Day Before Surgery

The Day Surgery department will call you the night before your surgery to let you know what time to arrive. You will be asked to come to the hospital at least two hours before your scheduled surgery time. As a general rule, you will be asked not to eat or drink anything after midnight the night before surgery. Most often you can take your routine medications with a sip of water. Medication guidelines will be discussed at your pre-operative visit.

You may also be instructed to complete a gentle bowel prep to clean out your bowels prior to surgery. This should be done starting the day before surgery.

You should plan to stay overnight in the hospital at least one night. This surgery may require a multiple night stay. Please leave all valuables at home and wear comfortable clothing.

Medications on Discharge
Common medications you may be prescribed on discharge:

1. Pain medication
2. Steroids (prednisone, hydrocortisone): The adrenal gland is responsible for secreting a steroid called cortisol. Cortisol is released by the body in response to stress. Steroids are sometimes needed after an adrenal gland is removed.
3. Blood Pressure Medications: Your blood pressure medications may be changed or stopped after your surgery. The removal of an adrenal gland may alter the hormones secreted by your adrenal gland that regulate blood pressure. You may not require the same amount of medication that you took before surgery.

After Surgery

Approximately 1-2 weeks following surgery, you will return to clinic to meet with your surgeon. At this time you will also meet with a nurse or nurse practitioner who will review instructions regarding caring for your wound and other post-operative issues. Your medications will be slowly adjusted; your surgeon, endocrinologist and primary care physician will manage this.