Endocrine surgery involves the treatment of diseases affecting endocrine organs or networks to achieve hormonal or anti-hormonal effects in the body. Since these organs are anatomically and physiologically diverse, lesions are often managed by surgical location rather than by generic endocrine surgeons. For example, upper gastrointestinal surgeons may treat pancreatic lesions, adrenal lesions may be resected by urologists and ENT surgeons may operate on the thyroid and parathyroids. This requires exemplary multidisciplinary interaction with endocrinologists, radiologists and pathologists, together with other essential members of the team.
Endocrine surgery has common principles and themes. Incongruities in homeostatic positive and negative feedback mechanisms produce systematic abnormalities, which can then be localized anatomically. Endocrine surgeons must deal with duality; physiology and morphology; function and form; over-activity and tumour formation.
A number of fascinating endocrine diseases, such as the MEN syndromes, are very rare indeed and have a status that belies their incidence; however, the principles of management are fundamental to endocrine surgery.
Goitres are very common and are defined clinically as any enlargement or change in consistency of the thyroid gland. Examination by ultrasound will show about 40% of middle-aged females to have nodular change in their thyroids. The thyroid produces hormones that influence metabolism; normal euthyroid control is maintained by thyroid stimulating hormone (TSH) from the pituitary. Alterations and diseases can produce over-activity (toxicity or hyperthyroidism) or under-activity (myxoedema or hypothyroidism).