Diagnosis Information:
Endocrine Diseases

The following are diseases suitable for consultation with an endocrine surgeon.

Multinodular Goiter Disease
This was a relatively common disease until iodine was put in the table salt in the early part of the 20th century. This is now still occurring on a sporadic basis, but not due to iodine deficiency. The disease consists of multiple, soft nodules within the thyroid slowly coalescing and growing. These cause symptoms either based on sheer size or based on extension behind the collarbone. In that location, the growth of the goiter causes compression of the windpipe and difficulty breathing or swallowing. Treatment for multinodular goiter, when symptomatic, is thyroidectomy. 

Hyperthyroidism (Graves' Disease) 
This disease is characterized by diffuse enlargement of the thyroid, bulging of the eyes, and too high a metabolic rate. Patients are frequently nervous, jittery, hot, and losing weight. This condition is most commonly treated with a drink of radioactive iodine. However, there are circumstances, such as pregnancy, where this is not feasible. In selected circumstances, thyroidectomy is performed for this diagnosis.

Parathyroid Disease
The parathyroid glands very precisely control the amount of calcium in the bloodstream. This is critical because calcium is a major electrical ion. When calcium levels get too high, electrical systems start to slow down. When calcium levels get too low, patients have around the lips tingling and experience twitching of muscles. These small glands are located on the backside of the thyroid, deep within the neck.   

Hyperparathyroidism
This disease is caused by over-activity of one or more parathyroid glands. In the case of one gland, this is referred to as "parathyroid adenoma." In cases where all glands are affected, it is referred to as "parathyroid hyperplasia." Cancer of the parathyroid is vanishingly rare, but easily identified based on blood tests. The diagnosis of hyperparathyroidism is based on an elevated parathyroid hormone level for a given level of calcium in the blood. It is possible to have hyperparathyroidism with a normal blood calcium.

Hyperparathyroidism sets off a complex chain of events whereby the blood calcium is too high, and the patients have symptoms from that. In addition, because calcium is poorly absorbed from the diet, the source of the high calcium is the patient's bones. However, the kidneys are set to dump calcium out of the bloodstream at a level that does not rise in compensatory fashion. Therefore, as one develops this disease, calcium is leeched out of the bones and into the blood, and from the blood it gets dumped into the urine. This disease causes progressive and severe osteoporosis, in addition to kidney stones, on that basis. Treatment of hyperparathyroidism is identification and removal of the abnormal parathyroid gland (or glands). 

Adrenal Disease
The adrenal glands are located deep in the abdomen on top of the kidneys. They make three primary substances. One is adrenalin, which prepares one for a stressful situation. A second substance is cortisol, which enables the other hormones in the body to work properly. The final hormone is aldosterone, which regulates the amount of salt in the bloodstream.

Disorders of the adrenal can cause over-secretion of each of these substances. In the case of adrenalin, adrenalin-producing tumors cause severe high blood pressure in spasms. This can cause both heart attacks and strokes and is ultimately fatal if untreated. Adrenal tumors which produce cortisol cause high blood pressure, a change in appearance to a pear-shaped figure, with large stripes on the abdomen, and a moon-shaped face. There is a menstrual disturbance early in this condition. It also causes osteoporosis, and is ultimately fatal. Adrenal conditions over-producing aldosterone lead to high blood pressure with a low potassium. All of these conditions can be very precisely diagnosed with a combination of blood and urine tests, in addition to, body imaging with CT scan or MRI. They each generally require adrenalectomy, removal of the affected adrenal gland, for treatment.

Rare Hormone-Producing Tumors
Carcinoid is a rare gastrointestinal tumor, which causes severe body and facial flushing. It can be diagnosed with a urine test, and is treated with surgery. Islet cell tumors are tumors associated with tissue of the pancreas gland. There are several types of these. The most common, gastrinoma, causes elevated levels of a hormone which augments stomach acid production and produces ulcers. A second type of islet cell tumor, insulinoma, produces too much insulin and causes seizures, fainting, and low blood sugar. Other types, such as glucagonoma and somatostatinoma, cause changes in bowel habits, body weight, and skin appearance. These tumors can occur in multiple combinations, which are easily definable and familial.