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Endocrine Surgery

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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Frequently Asked Questions

Due to abdominal pain I underwent a CAT scan of my abdomen. I was told I have a pancreatic mass. Now what?
You should be referred to a surgeon that is comfortable performing pancreatic surgery. Most pancreatic masses will require surgery. The type of surgery depends greatly on the location of the mass within the pancreas.
I have a palpable mass on my thyroid. Do I need surgery?
Prior to surgery, you should have appropriate blood tests evaluating your thyroid function. You should also have a thyroid ultrasound and most likely, a fine needle aspirate (FNA) of the thyroid mass. FNA's help decide who should have surgery based on what the cells look like under a microscope. Patients may also be considered surgical candidates if they have obstructive type symptoms such as breathing problems from compression, difficulty swallowing or severe pain.
I was told I have an adrenal mass. Do I need surgery? Can it be done with a minimally invasive technique?
Surgery for adrenal tumors depends upon the size of the mass and whether or not it is a functioning tumor. Some adrenal tumors secrete certain compounds that do make surgery necessary. Tumors of the adrenal gland that are five centimeters or larger are recommended for removal because of the risk of being cancer. Most patients with an adrenal tumor are candidates for a laparoscopic approach, as long as your surgeon has the experience necessary to perform such surgery.
Six months ago I had severe pancreatitis and now I've been told my follow-up CAT scan shows a pancreatic pseudocyst. This is causing me severe pain. What can be done?
Large, symptomatic, mature (thick walled) pseudocysts usually require surgery. These are usually drained into the stomach or small intestine. It's possible this can be addressed laparoscopically.

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