In order to avoid complications, it is important that patient and surgeon are prepared to the procedure. Patient need to have all his/her comorbidities well evaluated and appropriately treated before the adrenalectomy. Aldosteronoma can result in hypokalemia that may require potassium repletion and administration of potassium-sparing diuretic. Hypertension should also be treated before surgery. With a pheochromocytoma , α-adrenergic blockade should be started 2 weeks before surgery. Some patients with tachycardia may benefit from concurrent β blockade. Alternatively, an α1-selective blocker such as prazosin or doxazosin can be used. Intraoperatively, high blood pressure can be treated with nitroprusside or a short-acting β-blocker like esmolol. Volume repletion is important to prevent the postoperative hypotension secondary to loss of tonic vasoconstriction after removal of a pheochromocytoma. Patients with Cushing’s syndrome require correction of electrolyte abnormalities and hyperglycemia before surgery. These patients may benefit from administration of adrenolytic agents such as mitotane or aminoglutethimide.

Bowel preparation is not routinely necessary and should be performed only in cases of complex surgeries (i.e., large mass or intense intra-abdominal adherence). Retroperitoneal surgery may not require this bowel preparation. All patients should receive appropriate preoperative antibiotics. A nasogastric or orogastric tube should be placed. The placement of a urinary catheter to help measure urine output and to decompress the bladder is mandatory.