The Handbook of Endocrine Surgery

Contents......Page 8
Contributors......Page 20
Foreword......Page 36
Preface......Page 38
I. THYROID......Page 40
TSH (Normal Range 0.4–5.50 mU/L)......Page 42
T4......Page 44
Free T4 (Normal Range 0.8–2.7 ng/ml)......Page 45
T3......Page 46
Free T3 (Normal Range 2.3–4.2 pg/mL)......Page 47
Anti-TPO Antibodies (Normal is Negative)......Page 48
TSH Receptor Antibodies (Normal < 125% of Basal Activity)......Page 49
Thyroglobulin (Normal 3.5–56 ng/mL; After Thyroidectomy <2 ng/mL)......Page 50
Selected References......Page 52
Introduction......Page 54
Ultrasound......Page 55
Initial Ultrasound Examination......Page 57
Ultrasound Surveillance in Differentiated Thyroid Cancer......Page 59
Computed Tomography (CT)......Page 60
Radionuclide Scanning......Page 61
Positron Emission Tomography (PET) and PET/CT......Page 62
Selected References......Page 64
Overview......Page 66
Technique......Page 67
Core Needle Biopsy......Page 69
FNA Adequacy Assessment......Page 70
Recommendations......Page 71
Selected References......Page 77
History......Page 78
Physical Examination......Page 79
Laboratory Investigations......Page 81
Imaging......Page 82
Indications for Fine Needle Aspiration Biopsy......Page 83
Thyroid Nodule Management after FNAB......Page 84
Management of a Benign Thyroid Nodule......Page 85
Management of Thyroid Cysts......Page 86
Selected References......Page 87
Controversies in Surgical Management......Page 88
Overview......Page 90
Assessment for Nodal Metastases......Page 91
Practical Advice......Page 92
Overview......Page 93
Preparation for Treatment......Page 94
TSH Suppression......Page 95
Long-Term Followup......Page 96
Management of Recurrent Disease......Page 97
Bone Metastases......Page 98
Selected References......Page 99
Introduction......Page 102
Characteristics......Page 103
Surgical Treatment......Page 104
Characteristics......Page 105
MEN2A or FMTC......Page 106
MEN2B......Page 107
Genetic Testing......Page 108
Timing of Surgery (Table 3)......Page 111
Management of Patients Without MTC at Thyroidectomy......Page 112
Role of Stimulated Serum Calcitonin Testing......Page 113
Management of CEA-Positive, Calcitonin-Negative Patients......Page 114
Management of Recurrent Disease......Page 115
Chemotherapy, Radiotherapy, and Other Treatments for Distant Metastatic Disease......Page 116
Selected References......Page 117
Introduction......Page 118
Hürthle Cell Cancer......Page 120
Evaluation for Metastatic Disease......Page 121
Thyroid Hormone Therapy......Page 122
Long Term Followup......Page 123
Treatment of Metastatic Disease......Page 125
Selected References......Page 126
Overview......Page 128
Treatment......Page 130
Followup......Page 131
Treatment......Page 132
Treatment......Page 133
Prognosis......Page 134
Treatment......Page 135
Treatment......Page 138
Selected References......Page 139
Epidemiology......Page 140
Diagnosis......Page 141
Imaging......Page 142
Staging and Prognosis......Page 143
Treatment......Page 144
Diagnosis......Page 145
Rare Tumors of the Thyroid Gland......Page 146
Selected References......Page 147
Medical Management......Page 148
Radioactive Iodine......Page 153
Graves’ Disease......Page 155
Toxic Multinodular Goiter (Plummer’s Disease)......Page 159
Solitary Toxic Adenoma......Page 160
Treatment......Page 161
Selected References......Page 162
Differential Diagnosis......Page 164
Management......Page 165
Recurrent Laryngeal Nerve (RLN) Injury......Page 166
Selected References......Page 167
Overview......Page 168
Airway Compromise?......Page 169
Overview......Page 170
Selected Reference......Page 171
Evaluation and Management......Page 172
Horner’s Syndrome......Page 173
Injury to the Spinal Accessory Nerve......Page 174
Selected References......Page 175
Pharmacology......Page 176
Indications......Page 177
Selected References......Page 182
II. PARATHYROID......Page 184
Sporadic Primary Hyperparathyroidism (SPHPT)......Page 186
Normocalcemic Hyperparathyroidism......Page 187
Inappropriate Secretion of PTH......Page 188
Differential Diagnosis......Page 189
Hyperthyroidism......Page 191
Secondary Hyperparathyroidism......Page 192
Hereditary Hyperparathyroidism–Jaw Tumor Syndrome......Page 193
Parathyroid Cancer......Page 194
Selected References......Page 195
Introduction......Page 198
Ultrasound......Page 200
Nuclear Imaging......Page 202
MRI......Page 204
Is there a role for invasive localization studies?......Page 206
What studies are required for the reoperative patient with recurrent or persistent disease?......Page 207
Selected References......Page 208
Indications......Page 210
Intraoperative PTH Testing......Page 212
Radioguided Approach......Page 213
Bilateral Exploration......Page 214
Intraoperative Nerve Monitoring......Page 215
Selected References......Page 216
Historical Background......Page 218
Epidemiology......Page 219
Pathophysiology......Page 220
Genetic Etiologies......Page 221
Adynamic Bone Disease (Aplastic Bone Disease)......Page 222
Biochemical Evaluations......Page 223
Medical Therapy......Page 224
Therapeutic Agents......Page 225
Indications for Parathyroidectomy in SHPT......Page 226
Preoperative Localization......Page 227
Surgical Strategies......Page 228
Surgical Outcomes......Page 230
Type of Parathyroidectomy......Page 231
Percutaneous Ethanol Injection......Page 232
Selected References......Page 233
Diagnosis......Page 242
Surgical Treatment......Page 243
Extent of Surgical Resection......Page 244
Management of Recurrent Disease......Page 246
Selected References......Page 247
Demographic Data......Page 250
Clinical Presentation......Page 251
Localization Studies......Page 253
Pathology......Page 254
Operative Management......Page 256
Medical Management and Adjuvant Therapies......Page 258
Selected References......Page 259
Epidemiology and Presentation......Page 262
Diagnosis......Page 263
Surgery......Page 264
Epidemiology and Presentation......Page 266
Surgery......Page 267
Epidemiology and Presentation......Page 268
Surgery......Page 269
Epidemiology and Presentation......Page 270
Surgery......Page 271
Diagnosis......Page 272
Surgery......Page 273
Genetic Testing......Page 276
Family Screening and Genetic Testing......Page 277
Selected References......Page 278
Etiology......Page 280
Clinical Manifestations......Page 281
Acute Treatment Options......Page 282
Selected References......Page 286
Thyroid Surgery......Page 288
Parathyroid Surgery......Page 289
Pathophysiology......Page 291
Postoperative Monitoring......Page 292
Treatment of Postoperative Hypocalcemia......Page 293
Calcium Salts......Page 295
Vitamin D Formulations......Page 296
Calcitriol......Page 297
Prophylactic Treatment......Page 298
Selected References......Page 299
Introduction......Page 304
Methods for Cryopreservation of Parathyroid Tissue......Page 305
Long Term Storage, Viability, and Thawing of Cryopreserved Glands......Page 307
Method for Thawing of Cryopreserved Parathyroid Tissue......Page 308
Procedure for immediate or delayed (CHPA) autotransplantation......Page 309
Post-Operative Management Following Parathyroid Autotransplantation......Page 310
Outcome Evaluation Following Autografting......Page 311
Selected References......Page 313
III. ADRENAL......Page 316
Ruling out Functional Tumors......Page 318
Radiographic Assessment......Page 323
Guidelines for Resection......Page 324
Selected References......Page 325
Introduction......Page 326
Case Detection for Endogenous Hypercortisolism: Who Should be Evaluated......Page 327
Laboratory Evaluation......Page 328
Subtype Evaluation and Imaging......Page 330
Selected References......Page 336
Overview......Page 338
Metanephrines......Page 340
Catecholamines......Page 342
Provocation and Suppression Tests......Page 343
Chromogranin A (CgA)......Page 344
Method for Genetic Testing......Page 345
Prioritization of Gene Testing......Page 347
CT Imaging......Page 348
MIBG Scintigraphy......Page 349
Octreotide Scintigraphy......Page 350
Selected References......Page 351
Introduction......Page 354
Plasma Aldosterone Concentration (PAC) to Plasma Renin Activity (PRA) Ratio......Page 355
Computed Tomography......Page 357
Additional Laboratory Tests......Page 358
Measurement of Serum Aldosterone Levels......Page 359
Fludrocortisone Suppression Test......Page 360
Furosemide (Lasix) Stimulation Test......Page 361
Metoclopramide (Reglan) Test......Page 362
Selective Adrenal Venous Sampling......Page 363
(6 β-131I)Iodomethyl-19-Norcholesterol Scintigraphy\n\n(NP-59 Scintigraphy)......Page 365
Selected References......Page 366
Right......Page 368
Left......Page 372
Operative Approaches......Page 376
Key Steps of the Procedure......Page 377
Selected References......Page 379
Preoperative Considerations......Page 380
Postoperative Considerations......Page 386
Perioperative Considerations and Medical Management of Primary Hyperaldosteronism......Page 387
Perioperative Considerations......Page 389
Postoperative Considerations......Page 391
Adrenal Insufficiency......Page 392
Selected References......Page 394
Hereditary Tumor Syndromes Associated with ACC......Page 396
Imaging......Page 397
Pathology......Page 398
Postoperative Pathologic Risk Factors......Page 399
Operative Management......Page 400
Evaluation and Management of Patients with Metastatic Disease......Page 401
Adjuvant Therapy......Page 402
Radiation Therapy......Page 403
Selected References......Page 404
IV. ENDOCRINE PANCREAS......Page 406
Overview......Page 408
Serotonin Metabolism Markers......Page 409
Other Biochemical Markers......Page 411
OctreoScan......Page 412
Other Nuclear Scintigraphy Modalities......Page 413
Selected References......Page 414
Introduction......Page 416
Glucose and Insulin Levels (Normal Glucose Level 60–95 mg/dL at Fasting; Normal Insulin Level Below 30 µU/mL)......Page 417
72 h Prolonged Fasting Test......Page 418
Oral Glucose Tolerance Test......Page 419
Provocative Tests......Page 420
Imaging Evaluation......Page 421
Selected References......Page 429
Presentation......Page 430
Diagnosis......Page 431
Localization......Page 434
Clinical Presentation......Page 436
Diagnosis......Page 437
Clinical Presentation......Page 438
Clinical Presentation......Page 440
Selected References......Page 442
Overview......Page 444
Midgut Small Bowel Carcinoids......Page 445
Presentation of Small Bowel Carcinoids......Page 446
Carcinoid Syndrome......Page 447
Appendiceal Carcinoids......Page 459
Goblet Cell Carcinoids......Page 460
Selected References......Page 461
Operative Planning and Approach......Page 462
Operative Technique......Page 464
Postoperative Management......Page 465
Special Circumstances......Page 466
Selected References......Page 468
Overview......Page 470
Medical Management of Primary Gastrinomas......Page 479
Selected References......Page 480
Overview......Page 482
Imaging......Page 483
Pathology......Page 485
Operative Management of nfPNETS......Page 487
Approach to Hepatic Metastases......Page 488
Systemic Treatment Options......Page 490
Selected References......Page 492
Index......Page 494