Endocrine Surgery: Endocrine Surgery is the surgical subspecialty which deals with the diagnosis and management of surgical diseases of the endocrine glands. These include the thyroid, parathyroid, adrenal and pancreas.
Thyroid: Surgical diseases of the thyroid gland include benign nodules, thyroid cancers, and hyperfunctioning states such as Graves disease. Thyroid nodules are commonly discovered on physical exam or when a radiologic study of the neck is performed for other reasons. Most of these nodules are benign, but about 10% can contain thyroid cancer. The initial workup of these nodules is most often performed by primary care physicians, endocrinologists, or endocrine surgeons.
The evaluation will include laboratory analysis, ultrasound, and often a fine needle biopsy. Both diagnostic ultrasound and ultrasound-guided fine needle aspiration biopsy of the thyroid are performed in the office, and can usually be accomplished at the time of first consultation. If the biopsy diagnoses or raises suspicion for thyroid cancer, a thyroidectomy is usually necessary. The ultrasound also allows for a thorough evaluation of lymph nodes that may be involved with thyroid disease.
Benign thyroid diseases such as multinodular goiters, enlarging nodules causing compression, or Graves’s thyroiditis are also frequently treated with thyroidectomy. Thyroidectomy is performed with the patient under general anesthesia, and requires an overnight stay in the hospital. Recovery is relatively quick with little pain.
Parathyroid: Hyperparathyroidism is a common disorder that results from overgrowth of one or more of the four parathyroid glands that reside next to the thyroid gland. Subsequent overproduction of parathyroid hormone (PTH) leads to high serum calcium levels due to loss of calcium from bone, and increased calcium absorption in the intestine and kidney. The possible consequences of hyperparathyroidism include kidney stones, osteoporosis, fatigue, muscle and bone pain, constipation, gastroesophageal reflux, depression, and decreased mental acuity.
Once a diagnosis of hyperparathyroidism is suspected due to high calcium and PTH levels, surgery to remove the enlarged gland(s) is usually recommended. The evaluation includes additional laboratory analysis, as well as localizing studies to identify the location of the enlarged gland(s). An in office ultrasound is always performed as part of the initial consultation. Additional studies may be obtained as needed, including sestamibi or CT scans.
Surgery is usually performed under general anesthesia, and is often completed in under an hour. Incisions are very small and there is little post-operative pain. Recovery is relatively quick. Intra-operative PTH monitoring is available to confirm removal of all abnormal parathyroid tissue.
Adrenal: There are two adrenal glands, one just above each kidney. They secrete multiple hormones including cortisol, catecholamines (adrenalin), mineralocorticoids (aldosterone), and sex steroids. Growths on the adrenal glands may or may not overproduce any of these hormones. Most adrenal tumors are benign and non-functional. The most common functioning adrenal tumors produce several well recognized conditions.
Cushing’s syndrome occurs when cortisol is overproduced. It leads to weight gain, osteoporosis, hypertension, diabetes, weakness, and altered mood. Pheochromocytoma is a tumor that oversecretes catecholamines, which leads to headaches, episodes of sweating and palpitations. Hyperaldosteronism occurs when the tumor secretes aldosterone, and it leads to hypertension and low potassium levels.
When an adrenal tumor is identified, blood and/or urine testing is performed to determine if hormones are being overproduced. Most hormone secreting tumors require surgery. Non-functional tumors can often be followed with CT scans to ensure they are not growing. If there is suspicion for cancer of the adrenal gland, an adrenalectomy is usually necessary, as biopsies of the adrenal gland are not accurate.
Most adrenal tumors are removed with laparoscopic surgery. Patients receive general anesthesia, and then have three or four small incisions made in either the abdomen or back, where the camera and instruments are inserted. Usually adrenalectomies are performed in under two hours. Pain is kept to a minimum due to the laparoscopic technique. An overnight hospital stay is necessary, and the vast majority of patients go home the next day.
Panreatic neuroendocrine tumors: Endocrine tumors of the pancreas are uncommon. They are often found when a CT scan of the abdomen is performed for other reasons. Many of these tumors are benign, but some can exhibit malignant behavior. Sometimes they will secrete hormones that can cause symptoms of low blood sugar, peptic ulcer disease, rash, or diarrhea. Some of the possible pancreatic tumors are called insulinomas, gastrinomas, glucagonomas, and VIPomas. Many of these tumors can be removed laparoscopically, but sometimes an open operation is required.
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Endocrine Surgery Specialists
Elizabeth L Altenhein, MD
Peter J Mazzaglia, MD, FACS
Travis M Cotton, MD