Thyroid conditions managed by endocrine surgeons include multinodular goiter (enlarged thyroid gland due to many nodules); Graves’ disease (autoimmune disorder causing overactive thyroid); and various kinds of thyroid cancer, among others.
The most common parathyroid disorder treated by an endocrine surgeon is primary hyperparathyroidism, an elevation in the amount of hormone produced by the parathyroid gland that results in high levels of calcium in the blood. This can cause osteoporosis (decreased bone mineral density), kidney stones, abdominal pain or pancreatitis, a number of vague symptoms such as fatigue, depression and memory loss, or it may be entirely without symptoms. Endocrine surgeons also treat other forms of hyperparathyroidism, such as occur in patients with kidney failure, as well as the very rare cases of parathyroid cancer.
Adrenal tumors are often found when patients undergo imaging, such as a CT scan, for other reasons. Some may be observed, while others may require surgical removal. Those that produce excessive amounts of hormones, such as aldosterone, cortisol, sex steroids, or catecholamines (adrenaline-like compounds), should be removed to stop the effects of the over-secreted hormone. Other tumors should be removed based upon their size, as the risk of a cancerous growth increases as the tumor becomes larger; tumors over 6 cm should be removed for this reason, while some between 4-6 cm may be recommended to be removed because of their appearance on CT scan or MRI. Adrenal glands may be removed either with a laparoscope (keyhole surgery), or by an open (traditional incision) approach. Most endocrine surgeons prefer the laparoscopic approach, whenever it is safe and feasible.
Some tumors of the gastrointestinal tract act like endocrine tumors. They are commonly called carcinoids and can be found anywhere from the stomach to the rectum. While treatment varies depending on their location and size, endocrine surgeons are often involved in the surgical management of these cases.
Unlike the more common pancreatic adenocarcinoma, some tumors of the pancreas produce hormones, such as insulin or gastrin. While not all of these tumors will spread beyond the pancreas, we do not yet have a good way of knowing which will (meaning they are malignant), and which will not. This is an ongoing area of research and debate in the endocrine surgery and oncology community. Controlling the hormone excess either by surgical or medical means is the goal of therapy. An endocrine surgeon has the training to understand which tumors should be treated surgically and which can be managed with medical therapy. A good relationship between the endocrine surgeon, the endocrinologist, and other members of a multi-disciplinary team is critical to the management of these often complicated cases.
There are a number of familial disorders(genetic diseases) that are characterized by endocrine tumors. Among these are von Hippel-Lindau disease, Multiple Endocrine Neoplasia types I, IIa, and IIb, Neurofibromatosis type I, familial thyroid cancer syndromes, and Familial Paraganglioma Pheochromocytoma Syndrome(s). Endocrine surgeons have studied the genetic mutations that cause these disorders as well as the physical effects resulting from those mutations. They often care for many members of the same family who suffer from one of these syndromes. With the assistance of a trained geneticist, and the co-managing endocrinologist, an endocrine surgeon can help a patient better understand his or her disease, as well as what the implications for other family members might be. Should a patient require surgery for a tumor caused by a familial endocrine disorder, an endocrine surgeon is properly trained to take into account what future tumors may develop and how operations in such an individual may be affected.