The endocrine system is made up of several organs that regulate the body to maintain homeostasis in the body. That is to say they help regulate things like our metabolism, growth, digestion, sleep, mood, etc. The organs involved include the pituitary gland, pineal gland, thyroid gland, parathyroids glands, adrenal glands, pancreas, and ovaries/testis.
At Southwest General Surgery we focus mainly on the surgical treatment of diseases of the thyroid gland, parathyroid glands, pancreas, and adrenals. We have extensive experience operating on these organs and are very comfortable the various operations. The information below is general and every patient is different. We would be happy to talk about your specific case and discuss the appropriate work-up and treatment of your issue.
There are several reasons to be referred to a surgeon for consultation of thyroid disorders. The most common cause would be a nodule or growth on the thyroid that is concerning for cancer. Most of these nodules can be evaluated initially with a small needle used to collect cells from the nodule. If cancerous cells are found, surgery is generally needed to remove the gland and possibly surrounding lymph nodes. However, there are times when it is unclear whether the cells are cancerous or not. In this situation it is generally recommended that the part of the thyroid with the nodule be removed to confirm whether it is benign or malignant.
Other reasons for removal of the thyroid, or thyroidectomy, include benign nodules that have grown large enough to cause compressive symptoms on surrounding structures. These are called goiters. Also, surgical removal of the thyroid gland is a definitive cure for hyperthyroidism and is faster, more reliable, and generally cheaper than radioactive iodine, which can take several months and several doses to achieve the desired effect.
The parathyroid glands are responsible for calcium levels in the body. They regulate how much calcium is absorbed from the GI tract and secreted in the kidneys. They also control calcium absorption/deposition in bones. Most people have 4 glands that are about the size of a grain of rice and are situated around the thyroid gland. Abnormal elevations of calcium in the blood can be caused by parathyroid adenomas, or abnormal enlargement of one or all of the parathyroid glands. This high calcium can lead to symptoms of kidney stones, salivary duct stones, osteopenia or osteoporosis leading to broken bones, muscular pains, and even changes in mood and hallucinations. Surgical removal of one or all of the glands may be indicated in this situation.
Surgical removal of the adrenal gland is typically required for growths in the gland that can lead to abnormal secretion of several different hormones that the adrenal gland makes. These growths include pheochromocystomas, aldosteronomas, and cortisol secreting growths (Cushing's Syndrome). We are also seeing more and more masses found in the adrenal gland incidentally with imaging studies like CT scans and MRI's done for other reasons. These are called adrenal incidentalomas and typically followed with imaging unless they have concerning characteristics until they reach 4-6 cm based on other imaging findings. Once they reach this size, and most don't, there is concern for malignancy and adrenalectomy is recommended.
Once all the initial work-up is completed and surgery is indicated for an adrenal mass, we typically try to complete it laparoscopically if possible.
The pancreas is a very complex organ that has many functions in digestion, GI motility, and blood sugar control. It can also be damaged by many different causes that lead to pancreatitis.
Tumors of the pancreas can be benign or malignant and can arise in any part of the pancreas from the head of the gland to the tail. These tumors have many different names based on the cells involved and whether they secrete any hormones. These include adenocarcinomas, cystadenocarcinomas, cystadenomas, VIPomas (vasoactive intestinal peptide), insulinomas, gastrinomas (Zollinger-Ellison Syndrome), and IPMN's (indraductal papillary mucinous neoplasms). Large cysts, called pseudocysts, can also arise as a sequelae of acute pancreatitis. Surgical consultation is generally needed for any of these diagnoses.
Though we have extensive experience operating on the pancreas, we do not perform all the operations of the pancreas on a regular basis. For this reason we feel that most patients with tumors in the head of the pancreas would be better served with a referral to a surgeon who performs the Whipple procedure (removal of the head of the pancreas) regularly. We are comfortable, however, offering operations on the tail of pancreas for most indications. We would be happy to discuss your specific diagnosis and if needed direct you to the appropriate surgeon for the care of your problem if it is not us.