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Bruce E. Freedman, M.D., F.A.C.S.
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Endocrine Surgery
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Endocrine surgery is a very broad topic that has to do with glands that secrete substances that act on other organs elsewhere in the body.  Examples of endocrine glands are the parathyroid (responsible for calcium homeostasis), thyroid, adrenal, and pancreas. All of these glands can exhibit both benign and malignant changes.  Parathyroid glands can enlarge (hyperplasia) and become hyper-functioning.  Any one of the glands can enlarge (adenoma).  This results in elevated serum calcium, which can cause a whole host of internal derangements.  Surgical therapy depends upon the clinical situation.

The thyroid gland can develop nodules, both benign and malignant. If it is determined by ultrasound there is a solid thyroid nodule, the next step is usually FNA (fine needle aspirate).  The results of FNA usually determines the need for surgery.  Postoperative treatment with radioactive iodine (I113) is usually necessary following surgery for thyroid malignancies.

Pancreatic problems may be related to or caused by other benign conditions such as gallstones or alcoholism.  Pancreatic cancers are also possible.  Symptoms of pancreatic cancers vary depending upon where in the pancreas the cancer is present.  Cancer in the head of the pancreas may present as painless jaundice due to obstruction of the biliary system.  Cancers of the body or tail of the pancreas may present as pain in the upper abdomen or back.  Radiological procedures usually help identify those patients with these problems.

Adrenal glands can also undergo both benign and malignant changes. The larger the adrenal mass the higher the likelihood of cancer. Cancer from other organs can wind up in the adrenal gland as well (metastatic cancer). Patients can still benefit from surgical removal at this stage. Benign tumors of the adrenal gland can also occur.  Patients can present with abnormal electrolytes or hypertension that is difficult to control.  Surgical removal of the affected gland is the treatment of choice.

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