Adrenal Center

The Augusta University Adrenal Center is one of only a few in the country that can provide complete care for patients with all aspects of adrenal disease by engaging in:

• Teamwork: Our team of experts consists of adrenal specialists from diverse disciplines including surgery, endocrinology, cardiology, radiology, pathology and research. This multidisciplinary tumor board reviews cases together to determine the best treatment plans for patients.
• Timely diagnosis: We provide laboratory and radiology evaluations (including CT scans and Adrenal Vein Sampling) all under one roof. Because of this, we can quickly and efficiently identify an adrenal disorder, giving you the answers that you need, and providing you with timely appropriate care.
• Advanced treatment: We provide safe surgical care by surgeons with expertise and specialized (fellowship) training in robotic and laparoscopic surgery, to patients who need one, or both adrenal glands, removed.
• Clinical research: In order to better understand the causes of adrenal disorders, and find the best treatments, we perform research and clinical trials. One of our studies looks at the adrenal hormone, aldosterone, and the role it may play in women’s heart disease. Our research develops better ways of diagnosing and treating our patients with adrenal disorders.

The August University Adrenal Center has a team of specialists who focus on the diagnosis, treatment, and care of adrenal patients.

Dr. Carlos M. Isales, is our endocrinologist who specialized in adrenal disorders.

Dr. Aaron Bolduc, is our minimally invasive surgeon who specialized in endoscopic surgical adrenal procedures.

Nicki Martinez de Andino, is the nurse practitioner and patient coordinator for the Adrenal Center.

Dr. Wendy Bollag, is involved with adrenal research and clinical trials.

Adrenal glands are small triangular glands located on top of both kidneys.  Sometimes these organs do not function properly due to genetics, injury, age or medications.  We treat many disorders and diseases of the adrenal glands that require clinical care by a physician or other healthcare professional.

• Adrenal Incidentaloma, these are adrenal tumors that happen to be found on imaging studies that were done for other reasons. It is important to evaluate this type of tumor because it may be making hormones or be early cancer. Also, they should be monitored to make sure they do not become functional tumors or malignant tumors.
• Cushing's Syndrome, a disorder caused by prolonged exposure to excess cortisol. Cortisol helps regulate blood glucose and blood pressure. Too much cortisol causes progressive weight gain, rounding of the face, increased blood pressure, and menstrual cycle alterations (in women) and feminization (in men). It can be caused by a pituitary gland tumor (Cushing’s disease), by adrenal gland tumors, or by hyperactivity of the adrenal glands.
• Pheochromocytoma, a tumor that makes excessive adrenaline (catecholamines). This type of tumor can cause headaches, racing heart rate, and dangerously high blood pressure. It is very important not to have this type of tumor biopsied as it can release adrenaline during the biopsy.
• Adrenal Cancer, also known as adrenocortical carcinoma, are rare tumors that may arise in the cortex (outside) or medulla (inside) of the adrenal gland. More than half of adrenal cancers are functional which means they produce adrenal hormones.
• Hyperaldosteronism, a disease in which the outer layer of the adrenal gland makes too much aldosterone, a hormone that helps the kidneys keep a balance of salt and water in the blood. If there is too much aldosterone produced, it will result in high blood pressure, also known as hypertension. Hypertension puts patients at risk for heart attacks, heart failure, strokes, kidney disease and early death.
• Hereditary Adrenal Disorders, genetics can play a part in how your adrenal glands work. You can’t prevent a hereditary adrenal disorder, but, if caught early and treated with hormone therapy or medication, these disorders can be successfully managed throughout your lifetime.
• Sex Hormone Producing Tumors, are more likely to be malignant than other adrenal tumors. They can be androgen (male sex hormone) secreting tumors, estrogen (female sex hormone) secreting tumors, or mixed sex-hormone secreting tumors.

Finding the correct diagnosis is the most important goal of our endocrinology team.  We use the latest techniques and imaging technologies to diagnose our patients.

Imaging tests

We use different imaging tests to determine the location, size, and other characteristics of adrenal tumors.

• Adrenal protocol CT scans use computer-processed combinations of multiple x-ray measurements to produce cross-sectional images of your adrenal glands.
• MRI scans use a magnetic field and radiofrequency waves to produce detailed images of your adrenal glands and kidneys.
• MIBG, PET and DOTATATE scans use radioactive particles that collect in the tumor, causing them to light up on the scan.

Other diagnostic tests and procedures

We also offer additional types of diagnostic tests and procedures, including, but not limited to:

• Adrenal vein sampling to determine which adrenal gland is producing excess hormones.
• Blood and urine testing to evaluate hormone levels.
• Dexamethasone suppression testing an artificial steroid test.

Our endocrinology specialists and surgeons will work with you to determine the best treatment options.  Adrenal issues are often managed with routine monitoring, medications, and if appropriate, surgery.  With surgery, we will always explore minimally invasive surgery (MIS) options first. Chemotherapy and radiation are sometimes needed if a patient has a malignant adrenal mass.

Medical Management

Endocrinologist will routinely evaluate for hormone abnormalities related to the adrenal problem and prescribe medications to balance the hormone levels as needed. Repeat imaging will be done to evaluate for changes in an adrenal mass.

Surgery

An adrenalectomy is a surgical procedure to remove one or both of the adrenal glands, which are located on top of the kidneys. Adrenalectomy is generally indicated for patients with adrenal tumors that are producing excess hormones or thought to be cancerous. Usually only one adrenal gland is removed. We offer:

Robotic or Laparoscopic Adrenalectomy

Minimally Invasive Surgery (MIS) has become the standard of care for most adrenal issues requiring surgery. Compared to open adrenalectomy, laparoscopic surgery has several benefits, including:

• Less pain after surgery
• Less pain medication used
• Smaller scars
• More rapid recovery
• Less complications

Open Adrenalectomy

Large incision surgical procedures are performed less frequently due to a higher rate of complications. However, open surgery is done in cases where caution must be exercised, for example if there is: cancer of the adrenal gland(s), a large adrenal tumor greater than 10cm, or a tumor with features suggestive of cancer.

Support services

The Augusta University Adrenal Center works with patients and families continuously from diagnosis and treatment to lifelong monitoring and disease management.  We also offer:

• Genetic counseling services for patients with hereditary adrenal disorders. We can test for genetic disorders and counsel patients and their families on their risks and which family members may need to be evaluated.