Hyperparathyroidism
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Endocrine Surgery Goals and Objectives
Lenox Hill Hospital Department of Surgery Endocrine Surgery Goals and Objectives Medical Knowledge and Patient Care: Residents must demonstrate knowledge and application of the pathophysiology and epidemiology of the diseases listed below for this rotation, with the pertinent clinical and laboratory findings, differential diagnosis and therapeutic options including preventive measures, and procedural knowledge. They must show that they are able to gather accurate and relevant information using medical interviewing, physical examination, appropriate diagnostic workup, and use of information technology. They must be able to synthesize and apply information in the clinical setting to make informed recommendations about preventive, diagnostic and therapeutic options, based on clinical judgement, scientific evidence, and patient preferences. They should be able to prescribe, perform, and interpret surgical procedures listed below for this rotation. All Residents are expected to understand: 1. Normal physiology and anatomy of the thyroid glands. 2. Normal physiology and anatomy of the parathyroid glands. 3. Normal physiology and anatomy of the adrenal glands 4. Normal physiology of the pancreatic neuroendocrine cells. 5. Normal physiology of the pituitary gland. Disease-Based Learning Objectives: Hyperfunctioning Thyroid and Hypothyroid State: 1. Physiology of Grave’s disease and toxic goiter. 2. Management of a patient in hyperthyroid storm. 3. Medical and surgical treatment options for hyperthyroidism. 4. Physiology of Hashimoto’s thyroiditis and hypothyroidism. Thyroid Neoplasm: 1. Workup of a cold thyroid nodule. 2. Surgical management of papillary, follicular, medullary, and anaplastic thyroid carcinoma. 3. Adjuvant therapy for thyroid neoplasms. 4. Postoperative medical management and long-term follow-up of thyroid cancer. Hyperparathyroidism: 1. Diagnosis and work-up of hypercalcemia and primary, secondary, and tertiary hyperparathyroidism. -
Surgical Indications and Techniques for Adrenalectomy Review
THE MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL DOI: 10.14744/SEMB.2019.05578 Med Bull Sisli Etfal Hosp 2020;54(1):8–22 Review Surgical Indications and Techniques for Adrenalectomy Mehmet Uludağ,1 Nurcihan Aygün,1 Adnan İşgör2 1Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey 2Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey Abstract Indications for adrenalectomy are malignancy suspicion or malignant tumors, non-functional tumors with the risk of malignancy and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The hormone-secreting adrenal tumors in which adrenalectomy is indicated are as follows: Cushing’s syndrome, arises from hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn’s syndrome, arises from an hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and Pheochromocytomas that arise from adrenal medulla and produce catecholamines. Sometimes, bilateral adre- nalectomy may be required in Cushing's disease due to pituitary or ectopic ACTH secretion. Adenomas arise from the reticularis layer of the adrenal cortex, which rarely releases too much adrenal androgen and estrogen, may also develop and have an indication for adrenalectomy. Adrenal surgery can be performed by laparoscopic or open technique. Today, laparoscopic adrenalectomy is the gold standard treatment in selected patients. Laparoscopic adrenalectomy can be performed transperitoneally or retroperitoneoscopi- cally. Both approaches have their advantages and disadvantages. In the selection of the surgery type, the experience and habits of the surgeon are also important, along with the patient’s characteristics. The most common type of surgery performed in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are more familiar with. -
Ese-Ensat-Acc-Guidelines-13-5-2018
European Society of Endocrinology Clinical Practice Guidelines on the Management of Adrenocortical Carcinoma in Adults, in collaboration with the European Network for the Study of Adrenal Tumors Martin Fassnacht1,2*, Olaf M. Dekkers3,4,5, Tobias Else5, Eric Baudin7,8, Alfredo Berruti9, Ronald R. de Krijger10, 11, 12, 13, Harm R. Haak14,15, 16, Radu Mihai17, Guillaume Assie19, 20, Massimo Terzolo20* 1 Dept. of Internal Medicine I, Div. of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany 2 Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany 3 Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands 4 Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands 5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark 6 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA 7 Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France 8 INSERM UMR 1185, Faculté de Médecine, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France 9 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy. 10 Dept. of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands 11 Dept. of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands 12 Dept. of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands 13 Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands 14 Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands 15 Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands 16 Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands. -
Hormonally Active Adrenocortical Carcinoma in a 24-Year Old Woman
ACS Case Reviews in Surgery Vol. 1, No. 1 Hormonally active adrenocortical carcinoma in a 24-year old woman AUTHORS: CORRESPONDENCE AUTHOR: AUTHOR AFFILIATIONS: Wachtel H1-4, Sadow PM2,4, Stathatos N3,4, Dr. Carrie Lubitz, MD, FACS 1 Massachusetts General Hospital, Dept. of Surgery, Lubitz CC1,4 Massachusetts General Hospital Div. of General & Endocrine Surgery, Boston, MA Yawkey Center for Outpatient Care, 7B 2 Massachusetts General Hospital, Dept. of 55 Fruit Street Pathology, Boston, MA Boston, MA 02114 3 Massachusetts General Hospital, Dept. of Phone: 617-643-9473 Medicine, Div. of Endocrinology, Boston, MA Fax: 617-724-3895 4 Harvard Medical School, Boston, MA Email: [email protected] Background Adrenal tumors are common and frequently identified incidentally; adrenalectomy is indicated for functional tumors, masses ≥4 cm, and cases where malignancy is suspected. Summary A 24-year old previously healthy woman presented with a six-month history of weight gain, amenorrhea, hirsutism, acne, and hypertension. Biochemical evaluation revealed hypercortisolism and elevated DHEA-S. Abdominal imaging demonstrated an 11 cm right adrenal mass, abutting the right hepatic lobe, right kidney, and inferior vena cava. The patient underwent open right adrenalectomy for the presumptive diagnosis of hormonally active adrenocortical carcinoma (ACC). The tumor was able to be mobilized from surrounding structures without requiring resection of adjacent organs. Pathological exam demonstrated a 728 g, 16.5 cm ACC with extensive necrosis, and Ki67 proliferation index of 35% and large vessel vascular invasion. Postoperatively, the symptoms of hypercortisolism, virilization, and hypertension resolved. The patient is currently undergoing adjuvant mitotane therapy and has no evidence of disease six months after surgery. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
1 Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL
Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL BIFURCATION OCT06- 0201 LINEAR CRANIECTOMY 0050 IMPL CRT PACEMAKER SYS 0202 ELEVATE SKULL FX FRAGMNT 0051 IMPL CRT DEFIBRILLAT SYS 0203 SKULL FLAP FORMATION 0052 IMP/REP LEAD LF VEN SYS 0204 BONE GRAFT TO SKULL 0053 IMP/REP CRT PACEMAKR GEN 0205 SKULL PLATE INSERTION 0054 IMP/REP CRT DEFIB GENAT 0206 CRANIAL OSTEOPLASTY NEC 0056 INS/REP IMPL SENSOR LEAD OCT06- 0207 SKULL PLATE REMOVAL 0057 IMP/REP SUBCUE CARD DEV OCT06- 0211 SIMPLE SUTURE OF DURA 0061 PERC ANGIO PRECEREB VES (OCT 04) 0212 BRAIN MENINGE REPAIR NEC 0062 PERC ANGIO INTRACRAN VES (OCT 04) 0213 MENINGE VESSEL LIGATION 0066 PTCA OR CORONARY ATHER OCT05- 0214 CHOROID PLEXECTOMY 0070 REV HIP REPL-ACETAB/FEM OCT05- 022 VENTRICULOSTOMY 0071 REV HIP REPL-ACETAB COMP OCT05- 0231 VENTRICL SHUNT-HEAD/NECK 0072 REV HIP REPL-FEM COMP OCT05- 0232 VENTRI SHUNT-CIRCULA SYS 0073 REV HIP REPL-LINER/HEAD OCT05- 0233 VENTRICL SHUNT-THORAX 0074 HIP REPL SURF-METAL/POLY OCT05- 0234 VENTRICL SHUNT-ABDOMEN 0075 HIP REP SURF-METAL/METAL OCT05- 0235 VENTRI SHUNT-UNINARY SYS 0076 HIP REP SURF-CERMC/CERMC OCT05- 0239 OTHER VENTRICULAR SHUNT 0077 HIP REPL SURF-CERMC/POLY OCT06- 0242 REPLACE VENTRICLE SHUNT 0080 REV KNEE REPLACEMT-TOTAL OCT05- 0243 REMOVE VENTRICLE SHUNT 0081 REV KNEE REPL-TIBIA COMP OCT05- 0291 LYSIS CORTICAL ADHESION 0082 REV KNEE REPL-FEMUR COMP OCT05- 0292 BRAIN REPAIR 0083 REV KNEE REPLACE-PATELLA OCT05- 0293 IMPLANT BRAIN STIMULATOR 0084 REV KNEE REPL-TIBIA LIN OCT05- 0294 INSERT/REPLAC SKULL TONG 0085 RESRF HIPTOTAL-ACET/FEM -
Thyroid & Parathyroid Surgery
Thyroid & Parathyroid Surgery – Frequently Asked Questions How long will the operation take? What about neck stiffness and exercises? Thyroid and parathyroid operations generally take between one to Some neck stiffness is common as a result of the prolonged three hours. extension (backward tilting) of the head under the anaesthetic. The exercises recommended will reduce it but it may last for some Will I need a general anaesthetic? weeks and require physiotherapy as well. This type of surgery requires a general anaesthetic in order to stop Will my parathyroid glands be taken out with my thyroid? muscle movement during the delicate dissection. Often the anaesthetic is supplemented by local anaesthetic or a nerve block, If you are having thyroid surgery ("thyroidectomy") then every this may result in you having a numb face and ear for 24 hours attempt is made to preserve all your parathyroid glands. Mostly afterwards. they are left in place with their blood supply attached but, if that is not technically possible, they may need to be removed and How long will my incision be and where will it be placed? transplanted into the adjacent muscle. Sometimes very small parathyroid glands are buried under the thyroid capsule and For open thyroid or parathyroid surgery the scar is a curved line in cannot be identified at operation and so get taken out with the the "collar" position, about 2cm above the collar bone. The length thyroid specimen. Transplanted parathyroid glands take between varies depending on the size of the lump removed. For minimally 6 weeks to 6 months to recover, however the body can generally invasive surgery the scar is only 2 to 3cm long and is placed on get by with just part of one parathyroid gland if necessary. -
Thyroidectomy –
Thyroidectomy – an operation to remove all or part of the thyroid gland Information for patients page 2 What is the thyroid gland? The thyroid gland is an endocrine gland which makes hormones that are released into the bloodstream. These hormones affect cells and tissues in other parts of the body and help them to function normally. The thyroid is made up of two lobes, each about half the size of a plum. The two lobes lie on either side of your windpipe, with the gland as a whole lying just below your Adam’s apple. The thyroid gland produces three hormones, that are released into the bloodstream: • thyroxine, often called T4 • triiodothyronine, often called T3. In the body, T4 is converted into T3 and this is what influences the way cells and tissues work. • calcitonin – this is involved in controlling calcium levels in the blood. With medullary thyroid cancer (MTC), too much calcitonin is produced, however this does not lead to any significant change in calcium levels. Thyroxine and T3 can both be replaced by medication and the body can function perfectly well with little or no calcitonin. Thyroid hormones T3 and T4 help to control the speed of body processes – otherwise known as your metabolic rate. If too much of these thyroid hormones is released, your body starts to work faster than normal and you develop ‘hyperthyroidism’. This would make you feel overactive and anxious, hungrier than usual, and you would lose weight. However, if too little of these thyroid hormones is produced, your body will start to work slower than normal and you develop ‘hypothyroidism’. -
Journal of Endocrine Surgery
ORIGINAL ARTICLE The Korean Journal of ISSN 1598-1703 (Print) ISSN 2287-6782 (Online) Korean J Endocr Surg 2014;14:219-227 Endocrine Surgery http://dx.doi.org/10.16956/kaes.2014.14.4.219 Surgical Outcomes of Adrenocortical Carcinoma; 20 Years of Experience in a Single Institution Min Jhi Kim, Eun Jeong Ban, Soo Jung Jung, Hai Young Son1, Cho Rok Lee, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Cheong Soo Park Department of Surgery, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, 1International St. Mary’s Hospital, Incheon, Korea Purpose: Adrenocortical carcinoma (ACC) is a rare malignant tumor. Early detection is difficult and prognosis is poor. We report on 20 years of ACC surgical experience at our institution. Methods: This study included 32 ACC patients who underwent surgical resection at the Department of Surgery of the Yonsei University Health System in South Korea between January 1990 and February 2012. We reviewed these 32 patients and retrospectively analyzed long-term clinical outcomes and prognosis after radical surgery for ACC. Results: The median age of the 32 patients at diagnosis was 42.25 years (range 3∼81 years). There were 16 (50%) female and 16 (50%) male patients. Mean tumor size was 12.36 cm (range 1.8∼20 cm). Twenty-five patients (78.12%) had nonfunctioning tumors while the other seven patients (21.87%) had functioning tumors. Seventeen patients (53.12%) were classified as stage II, two (6.25%) as stage III, and 13 (40.62%) as stage IV. Fourteen patients underwent radical surgical resection, while 14 patients received adjuvant chemotherapy, two received adjuvant radiotherapy, and two received adjuvant chemora- diation. -
California Breast Cancer Research Program Special Research Initiatives
UC Office of the President UCOP Previously Published Works Title Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment Permalink https://escholarship.org/uc/item/02p5s6xr Publication Date 2007 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Identifying Gaps in Breast Cancer Research California Breast Cancer Research Program Special Research Initiatives Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment Editors Julia G. Brody, PhD Executive Director Silent Spring Institute Marion (Mhel) H.E. Kavanaugh-Lynch, MD, MPH Director California Breast Cancer Research Program Olufunmilayo I (Funmi) Olopade, MD Walter L. Palmer Distinguished Service Professor of Medicine University of Chicago Medical Center Susan Matsuko Shinagawa Breast Cancer and Chronic Pain Survivor/Advocate, Intercultural Cancer Council; Asian and Pacific Islander National Cancer Survivors Network Sandra Steingraber, PhD Author and Distinguished Visiting Scholar Ithaca College David R. Williams, PhD Department of Society, Human Development and Health Harvard School of Public Health Front Matter DRAFT 8/11/07 Page 1 California Breast Cancer Research Program Table of Contents Preface Introduction Section I: Exposures from the Physical Environment and Breast Cancer Overarching Issues A. Secondhand Smoke B. Environmental Chemicals/Pollutants 1. Air Pollutants, Fuels and Additives 2. Persistent Organic Pollutants 3. Polybrominated Flame Retardants 4. Pesticides 5. Solvents and industrial chemicals 6. Water Contaminants 7. Hormones in Food 8. Metals 9. Exposures from Polyvinyl Chloride 10.Bisphenol A C. Compounds in Personal Care Products D. Pharmaceuticals E. Infectious agents F. Ionizing Radiation G. -
The Relationship Between Bone Metabolism, Melatonin and Other Hormones in Sham-Operated and Pinealectomized Rats
ENDOCRINE REGULATIONS, VOL. 37, 211–224, 2003 211 THE RELATIONSHIP BETWEEN BONE METABOLISM, MELATONIN AND OTHER HORMONES IN SHAM-OPERATED AND PINEALECTOMIZED RATS Z. OSTROWSKA, B. KOS-KUDLA1, M. NOWAK1, E. SWIETOCHOWSKA, B. MAREK1, J. GORSKI, D. KAJDANIUK1, K. WOLKOWSKA Department of Clinical Biochemistry, 1Department of Pathophysiology and Endocrinology, The Medical University of Silesia, Zabrze, Poland E-mail: [email protected] Objective. The influence of pinealectomy and long-term melatonin (MEL) administration on circadian oscillations of selected biochemical markers of bone metabolism [serum alkaline phos- phatase (ALP) activity, carboxyterminal propeptide type I procollagen (PICP) and carboxyterminal telopeptide type I collagen (ICTP) concentrations as well as urinary excretion of hydroxyproline (HYP) and Ca] and possible involvement of circadian secretion of IGF-I, parathyroid, thyroid, adrenal cortex and gonads function in this mechanism was evaluated. Methods. Studies were performed in 192 adult male Wistar rats weighing 145±9 g which were subjected to pinealectomy or sham operation. In half of the animals from each group MEL (Sigma, USA) in a dose of 50 mg/100 g b.w. was administered intraperitonealy (daily between 17.00 and 18.00 h for a 4-week period). Material for studies (blood and urine) was collected every 3 hours during a day. Hormones, PICP and ICTP concentrations were determined with the use of RIA meth- ods, whereas ALP, HYP and Ca values - spectrophotometrically. Results. The study has shown that pinealectomy had an inducing, while exogenous MEL a suppressing effect upon the level of investigated biochemical markers of bone metabolism. Fur- thermore, substantial changes in the values of amplitude and phase of their circadian oscillations were shown. -
Tqehresearch 2009 Research Report
TQEHresearch 2009 Research Report TQEHresearch 2009 Research Report Contents 04 DIRECTOR OF RESEARCH REPORT 06 2009 RESEARCH PUBLICATIONS IN THE SPOTLIGHT 09 ANAESTHESIA, Department of 10 CARDIOLOGY UNIT 18 CLINICAL PHARMACOLOGY UNIT 21 DERMATOLOGY UNIT 22 ENDOCRINOLOGY UNIT 24 GASTROENTEROLOGY AND HEPATOLOGY UNIT 26 GYNAECOLOGY, Department of 28 HAEMATOLOGY AND MEDICAL ONCOLOGY, The combined Departments of 34 INTENSIVE CARE UNIT 39 MEDICINE, University of Adelaide Discipline of 44 NEUROLOGY UNIT 51 NUCLEAR MEDICINE UNIT 54 NURSING RESEARCH 55 OTOLARYNGOLOGY, HEAD AND NECK SURGERY, Department of 59 PSYCHIATRY, University of Adelaide Discipline of 61 RENAL UNIT 68 RESPIRATORY MEDICINE UNIT 70 RHEUMATOLOGY UNIT 72 SURGERY, University of Adelaide Discipline of 77 THERAPEUTICS RESEARCH CENTRE, University of South Australia 80 PUBLICATIONS 93 INVITED PRESENTATIONS 105 RESEARCH SUPPORT STRUCTURES 111 AWARDS 115 ACKNOWLEDGEMENTS 116 THE QUEEN ELIZABETH HOSPITAL RESEARCH FOUNDATION TQEHresearch Research Report 2009 2 TQEHresearch Research Report 2009 3 Professor Guy Maddern Director of Research Director of Research Report The Basil Hetzel Institute 2009 began with great enthusiasm as Alongside this move towards translational for Medical Research The groups moved into The Basil Hetzel Institute research has been the development of the Queen Elizabeth Hospital building at The Queen Elizabeth Hospital. South Australian Health and Medical Research Like all new buildings, there have been the Institute on North Terrace. The Common- inevitable problems in resolving small but wealth Government has allocated $200 irritating technical glitches but, at the time million to this new capital development and of writing this report, all but one major it is envisaged that it will have a central role problem has been satisfactorily resolved and for research in South Australia with a close the groups are enjoying their new environ- relationship to its nodes, such as the Basil ment.