Endocrine surgery deals with both benign and malignant diseases of the hormone-producing organs. The endocrine (hormone-producing) organs include the thyroid gland, the parathyroid glands, the adrenal glands, the endocrine part of the pancreas and the neuroendocrine cells. Here you will find further information as well as selected specialists and centers for endocrine surgery.
Both conventional surgical techniques and minimally invasive procedures are used in endocrine surgery. Doctors from different specialist areas work together. These are usually
Sometimes pathologists are also involved. They are involved in cancer diagnostics, i.e. when the tissue needs to be examined for possible degeneration (malignant tumors).
Particularly in the case of malignant diseases, subsequent tumor-specific follow-up treatment is usually necessary after endocrine surgery.
As part of endocrine surgery, operations on the thyroid gland are mainly performed for
are carried out.
In Germany, every second person over the age of 45 suffers from an enlarged thyroid gland (commonly known as a goitre ) or a nodule. If medication is not sufficient for treatment, endocrine surgery is used.
The surgical options for endocrine surgery include complete thyroidectomy and partial thyroidectomy.
It may also be necessary to remove lymph nodes in the case of thyroid cancer.
Endocrinological surgery on the parathyroid glands is usually required for
is used.
Surgeons carry out a success check during the operation. For this purpose, the tissue is examined under a microscope (histological control). The hormones secreted by the parathyroid gland can also be measured intraoperatively (so-called intraoperative parathyroid hormone measurement).
If possible, the diseased parathyroid gland is removed as a focused procedure using open or video-assisted endocrine surgery.
Endocrine surgery on the adrenal glands plays a role in adrenal tumors in particular.
The adrenal glands have a so-called adrenal cortex and an adrenal medulla. Tumors can occur in both structures.
One form of this is known as Cushing's syndrome. In this case, the hormone cortisol is produced in excess. This leads to
Other typical characteristics are the so-called full moon face and truncal obesity. This is a fat distribution disorder that leads to thin arms and legs and an increase in fat in the trunk area.
If the hormone aldosterone is produced in excess by an adrenal cortical tumor, Conn's syndrome develops. Typical symptoms are high blood pressure in conjunction with a markedly low potassium level in the blood.
The most common tumor of the adrenal medulla is pheochromocytoma. This leads to overproduction of the hormones adrenaline and noradrenaline. These lead to high blood pressure with
The best-known function of the endocrine part of the pancreas is to regulate blood sugar levels. It secretes the hormones insulin and glucagon.
Tumors that originate in the endocrine parts of the gland can be benign or malignant. An indication of a pancreatic tumor can be a yellowing of the skin(icterus), which is usually painless. Those affected sometimes complain of abdominal or back pain and lose weight unintentionally within a few months.
The location of the pancreas (center of the picture) © nerthuz | AdobeStock
An ultrasound scan is usually carried out before endocrine surgery. This allows other diseases that also lead to yellowing of the skin or abdominal pain to be detected or ruled out.
Tumors of the pancreas can also be detected with the help of computer tomography and magnetic resonance imaging. Sometimes a gastroscopy with probing and X-ray imaging of the pancreatic duct is necessary.
However, it is very difficult to differentiate between malignant tumor formation and chronic inflammation of the pancreas. This can often only be assessed during an operation.
Neuroendocrine tumors (NET) play a special role in neuroendocrine cell diseases. They mainly occur in the gastrointestinal tract. They can be divided into functional and non-functional tumors according to their ability to release hormones.
They require an endocrine surgery procedure adapted to the site of origin and the type of hormone production. In the case of neuroendocrine tumors, secondary tumors can occur in other organs at the same time as the initial tumor (primary tumor). These must then also be treated.
Endocrine surgery can be used to remove tumors and nodular changes in the thyroid gland and eliminate hyperthyroidism.
Thyroid surgery is now a routine procedure within endocrine surgery. In Germany, around 80,000 to 100,000 thyroid operations are performed every year.
The thyroid gland should be operated on in particular if other organs are constricted by its enlargement. For example, constriction of the respiratory tract or oesophagus can lead to swallowing or breathing difficulties or a feeling of pressure in the throat.
A severely enlarged thyroid gland can constrict other organs © Freelanceman | Adobe Stock
Other reasons for endocrinological intervention are
The endocrine surgeon will carry out various examinations:
An ear, nose and throat specialist may be consulted before endocrine surgery to check the function of the vocal cords. This must be decided on a case-by-case basis.
Most thyroid operations are performed under general anesthesia and take around one to two hours.
The thyroid hormones, which are tested by taking a blood sample, should be within the normal range at the time of endocrine surgery. This means that any malfunction (especially hyperthyroidism) should be treated with medication before endocrine surgery.
Thyroid surgery is performed via a small incision (4-5 cm) below the neck (so-called collar incision). The endocrine surgeon exposes the thyroid gland and removes diseased tissue.
How much tissue is removed depends on
Occasionally, an entire thyroid lobe or the entire thyroid gland has to be removed. In the case of thyroid cancer, the entire thyroid gland, including the surrounding lymph nodes, is usually removed.
If it is not clear whether the tumor is malignant, the removed tissue is examined during the thyroid operation (frozen section examination).
Before the wound is closed, a drainage tube is inserted to allow blood and secretions to drain away. The wound is usually closed with self-dissolving stitches.
The duration of hospitalization for thyroid surgery is usually two to three days. Patients can get up the day after the operation and are allowed to drink and eat.
The wound drains are removed on the first or second day. The skin sutures are removed on the fifth to seventh day, unless self-dissolving sutures were used. In most cases, the vocal cord function is also checked by an ear, nose and throat specialist.
All normal activities can usually be resumed around seven days after discharge from hospital.
Four to six weeks after the operation, the metabolic status is checked by taking a blood sample. A decision is then made as to whether and how much thyroid hormone should be administered.
In rare cases, the parathyroid glands are injured or unintentionally removed during thyroid surgery. They can then be implanted elsewhere (forearm, neck muscles). They usually resume their function after a few days.
However, it is not always possible to implant the parathyroid glands elsewhere. In this case, the resulting undersupply of calcium can be treated by taking a daily calcium supplement. Additional vitamin D may also be given if necessary.
Primary hyperparathyroidism is also known as parathyroid adenoma or parathyroid hyperplasia. It is cured by surgically removing the enlarged parathyroid gland as part of endocrine surgery.
Endocrine surgery should be performed if the disease has been detected by elevated calcium levels or elevated parathyroid hormone levels.
Occasionally, the location of the enlarged parathyroid gland cannot be precisely localized before the procedure. It may also be suspected that more than one parathyroid gland is altered. In both cases, all possible sites must be surgically dissected.
Illustration of the four parathyroid glands © Kateryna_Kon | AdobeStock
The removed tissue is examined histologically during the operation (frozen section examination). This checks whether the parathyroid adenoma has been successfully removed and rules out any malignancy.
If all four parathyroid glands are abnormally enlarged, three and a half parathyroid glands are removed and half a well-perfused parathyroid gland is left in place. This is common in cases of familial primary hyperparathyroidism.
Alternatively, all four enlarged parathyroid glands can be removed and small parathyroid tissue particles reimplanted.
The malignant change in a parathyroid adenoma is usually only detected during a histological examination of the parathyroid tissue. In endocrine surgery, an adenoma is suspicious if it is difficult to remove from its surroundings during surgery.
Extensive surgery must be performed if a malignant tumor is strongly suspected or detected. This means that even the smallest remnants of the tumor must be removed so that the tumor does not recur.
The same-sided thyroid gland is removed completely. This also includes the lymphatic tissue at the blood vessel sheaths and the lymph nodes that are affected by tumor tissue.
After removal of hyperfunctioning parathyroid gland(s), the bones are accustomed to high calcium concentrations in the blood. After the operation, the calcium concentration may temporarily fall below the normal range.
This can be treated by regularly taking calcium effervescent tablets, possibly in combination with vitamin D. However, the calcium level reached should not exceed the lower normal range. This allows the parathyroid glands to resume their function and also prevents the formation of calcium-containing kidney stones or renal calcification.
In the case of adrenal cortical tumors that cause Cushing's syndrome or Conn's syndrome, treatment consists of surgical removal of the tumor or the entire adrenal gland (adrenalectomy).
In the majority of cases, this procedure is performed using the keyhole technique (minimally invasive laparoscopic technique).
Adrenocortical carcinoma, a malignant tumor of the adrenal cortex, must also be removed using endocrine surgery. Drug and chemotherapeutic strategies are also required.
Anatomy of the kidney © bilderzwerg | AdobeStock
The standard procedure for adrenal tumors that are smaller than 6 cm and show no evidence of malignancy is laparoscopic adrenalectomy, or the laparoscopic removal of the diseased part of the adrenal gland.
The instruments are inserted into the right or left flank via three incisions of around 2-3 cm.
Pheochromocytoma is also treated using endocrine surgery. If the tumor is up to approx. 6 cm in size, this operation can be planned using the keyhole technique.
For larger tumors, there is a certain risk of malignancy. Therefore, in these cases, conventional surgery should be performed via a flank or abdominal incision so that no tumor parts are carried over.
Prior to surgery for pheochromocytoma, patients are treated with a special medication. It neutralizes the effects of adrenaline and noradrenaline on the blood vessels and can thus prevent incidents during the operation.
Regular follow-up examinations are necessary for pheochromocytomas and malignant adrenal tumors.
Before the operation, efforts should be made to improve any pre-existing conditions in other organs. The activity of the pancreas is reduced with medication before the operation.
The bowel is completely emptied the day before the operation. In most cases, a so-called diagnostic laparascopy is performed at the beginning of the procedure to avoid stressful major surgery. This involves examining the pancreas with a special ultrasound device.
If complete removal of the tumor appears possible, the operation is continued via a normal abdominal incision, otherwise it is terminated.
In principle, many pancreatic tumors only have a chance of being cured if the entire tumor can be removed. This often requires the removal of neighboring organs such as the duodenum or bile duct.
Pancreatic surgery involves the general risks and complications associated with all surgical procedures. In addition, inflammation of the residual pancreas must be taken into account after pancreatic surgery.
The histological examination of the pancreatic tissue removed during the operation takes about a week. The results are used to determine whether further medical treatment of the disease is necessary in order to increase the chances of a permanent cure.
Endocrine surgery is the first line of treatment for gastrointestinal neuroendocrine tumors.
Even very large or metastatic tumors are operated on in order to
This depends on the location and stage of the tumor.
It is also possible to alleviate the symptoms resulting from the hormone production of the tumor with medication. A combination of chemotherapeutic agents is also used.
Radiotherapy of neuroendocrine tumors, on the other hand, is not a therapeutic option.
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