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  • Print publication year: 2014
  • Online publication date: July 2014

Chapter 11 - Endocrine cases

Summary

Introduction

Endocrine surgery is predominantly focused on the surgery of the thyroid, parathyroid and adrenal glands. The care of patients with the rare endocrine pancreatic tumours and neuroendocrine tumours (carcinoids) is divided between endocrine surgeons, pancreatic surgeons and liver surgeons, based on the local expertise available in individual centres. Pituitary and testicular tumours are outside the remit of this chapter as they are dealt with by neurosurgeons and urologists, respectively.

For all conditions discussed in this chapter, the management of the patient has to follow the sequence described in Figure 11.1. History and clinical examination remain the cornerstone of an accurate diagnosis. For example, observing the subtle signs of Cushing’s syndrome will allow the astute clinician to consider this diagnosis in patients previously labelled as obese and depressed. Listening to the description of recurrent ‘attacks’ might trigger appropriate tests for phaeochromocytoma in patients who were previously treated for anxiety or primary hypertension. The combination of fatigue, depression, insomnia, abdominal discomfort, joint pains and nocturia might be dismissed as normal ageing but should raise the suspicion of hypercalcaemia of primary hyperparathyroidism.

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