[Conditions and requirements of adrenal surgery (author's transl)]

The adrenal cortex and the adrenal medulla, functionally quite distinct, re discussed separately. Knowledge of the steroid biosynthesis with its three productive pathways (glycocorticoids, mineralocorticoids and sex hormones) is essential not only to understand the physiopathology of the adrenal cortex, but also to delineate the necessary diagnostic hormonal screening tests and the applied treatment modalities. When surgery is indicated a precise preoperative evaluation of the patient is essential with correction of all possible anomalies. With this all in mind the Cushing syndrome, the adrenogenital syndrome and the primary aldosteronism (Conn) are discussed with regard to etiology and treatment. Patients who underwent a bilateral adrenalectomy are likely to live a normal life as long as the hormonal substitution therapy (glycocorticoids and mineralocorticoids) is adequate. When stress situations, such as surgery, do occur adjustments of this therapy are essential. The pathology of the adrenal medulla confronts us with the problems of pheochromocytoma. An adequate preoperative preparation of the patients with adrenergic blocking agents and fluid support allows for a surgical intervention with a low morbidity and mortality. In conclusion, surgery of the adrenals requires a perfect knowledge of the associated physiopathology and a close cooperation between the endocrinologist, the surgeon and the anesthesiologist.