Endocrine and Glandular Tumors
Several organs are glandular, secreting chemicals called hormones which exert important effects on other parts of the body. Hormone-secreting glands are called endocrine organs. These include the pituitary, the thyroid, the parathyroids, the adrenals, the pancreas, and the ovaries or testes.
Hormones are messengers which circulate through the blood stream and regulate many body functions like growth, blood sugar, metabolism, as well as salt and water balance. They can also impact sex anatomy and physiology. Some glands like the pancreas make both local secretions as well as hormones. Many of endocrine organs develop tumors that may be benign or malignant. The management of these tumors is often very specialized.
Benign endocrine and glandular tumors may cause pressure effects on neighboring structures, leading to symptoms that may include obstruction, pain or bleeding. Benign tumors may also produce excess levels of normal hormones that may create severe metabolic disruption.
Malignant endocrine and glandular tumors may cause all of the problems of benign tumors, but can additionally invade adjacent normal structures, as well as spread to other parts of the body. As with any malignant tumor, endocrine cancers can be life-threatening.
Dr. Hyams specializes in the management of endocrine and glandular tumors of the head and neck, and adrenal gland. He can help you understand these diseases and help you chart a course for treatment and recovery.
Thyroid Benign Tumors
Most thyroid nodules are not cancerous. They represent either localized benign cysts or tumors that pose no risk of spread throughout the body. However, sometimes these tumors may produce abnormally high levels of thyroid hormone, which is an unsafe condition that can lead to bothersome symptoms or even be life-threatening.
In some cases, there may be enlargement of the entire gland, either due to growth of non-cancerous nodules, or to diffuse growth of the gland. This can cause pressure symptoms, including production of too much phlegm, coughing, and swallowing difficulty.
An enlarged thyroid may also be unsightly, creating a “thick neck” or a disturbingly visible bulge.
Many of these require no intervention. Some bear followup imaging and intervention only if they grow or change. And, some are best managed by treatment with medication, radiation therapy, or surgery.
Having a specialist assess risk, and help in determining appropriate management, minimizes the chance of an undesirable outcome.
Thyroid Malignant Tumors
The majority of thyroid cancers are lower-risk well-differentiated thyroid cancers. These tumors are more likely in patients with radiation exposure to the neck, but can occur in anyone.
Treatment of well-differentiated thyroid cancer is usually surgical. It often involves removal of some or all, of the thyroid. Thyroid hormone may be replaced through the use of a daily inexpensive pill.
Like normal thyroid tissue, well-differentiated thyroid cancer cells are the only tissues in the body to take up circulating iodine. This provides an opportunity for treating minimal residual cancer with radioactive iodine, lessening exposure of normal tissue and increasing cure rate.
Unfortunately, more aggressive thyroid cancers may require more aggressive treatment, including total removal of the gland, lymph node removal, external radiation therapy, and even chemotherapy.
Assessment of personal and family risk history is important in evaluating any thyroid cancer, and planning a suitable treatment and follow-up pathway. A surgical oncologist with an endocrine surgery focus is best positioned to ensure the best outcome with the safest intervention.
Primary parathyroid Gland Disease:
Parathyroid glands are named because of their anatomic location near the thyroid. In fact, they have nothing to do with the thyroid physiologically.
There are normally four (sometimes more) parathyroid glands, each the size of a small lentil. These glands secrete a hormone that regulates calcium levels in the blood. As calcium is critical to muscle function, minute-to-minute regulation of its level is very important.
However, sometimes a parathyroid gland develops a small non-cancerous (benign) tumor that secretes increased amounts of parathyroid hormone. This tumor is called an adenoma.
Sometimes all glands just grow too much over time, producing too much hormone. This is called hyperplasia.
Rarely, a parathyroid gland may develop a cancerous tumor which makes too much hormone.
In all cases, the condition is treated with surgery, removing the tumor, or the excess tissue.
Failure to treat hyperparathyroidism can lead to increased risk of heart attack, stroke, bone weakness, tendon and ligament injuries, and skin wounds that may become gangrenous.
Elevated genetic risk may predispose some to parathyroid disease.
Assessment of personal and family risk history is important in evaluating parathyroid disease, and planning a suitable treatment and followup pathway. A surgical oncologist with an endocrine surgery focus is best positioned to ensure the best outcome with the safest intervention.
Secondary and Tertiary Parathyroid Gland Disease
When patients have failing kidneys, they excrete serum calcium at rates above normal. The parathyroid glands must secrete more and more parathyroid hormone in order to replace this lost calcium.
Over time, the parathyroid glands grow larger and the hormone levels get higher.
Once the kidneys fail, blood calcium levels may be maintained by dialysis. However, the parathyroid glands continue to grow and produce parathyroid hormone that may be more than 30 times normal.
Such high hormone levels may lead to heart attack, stroke, bone weakness, tendon disruption, and ligament injuries. Skin ulcers may rapidly enlarge and become gangrenous secondary to calcium deposits.
Removal of all parathyroid tissue, and auto-transplanting a portion of one parathyroid gland in the forearm, is an effective treatment. Should future parathyroid hormone levels rise, removal of a parathyroid tissue from the forearm is much easier than re-exploring the neck.
Dr. Hyams has extensive experience with this specialized treatment. After surgery, most patients will never be exposed to the risk of excess parathyroid hormone. They will have an easier time maintaining their phosphorous, and will avoid the side-effects and cost of medication which only partly controls this condition.
Other Endocrine Tumors
There are other endocrine organs, outside of the neck, for which specialized surgical intervention may be indicated.
Dr. Hyams has been trained to address these issues, and has a long experience using modern techniques. He also has access to a network of surgical colleagues in regional academic institutions, when hyper-specialized care is required.
In many cases, endocrine tumors located elsewhere in the body are associated with family and personal risk history, and many reflect genetic anomalies.
Assessment of the full range of issues is important in evaluating distributed endocrine tumors, and planning a suitable treatment and follow-up pathway. A surgical oncologist with an endocrine surgery focus is best positioned to ensure an optimal outcome with the safest intervention.
