Complications Of Endocrine Surgery

Introduction

Each organ manages a specific function in the body. Hormones, enzymes, and fluids are produced as secretion. These secretions regulate certain functions such as the body's metabolism, growth and development, and, most important, functions related to the reproductive system. The functioning of the endocrine system also regulates the maturation of the genital organs (gonads). Due to many reasons, certain pathological disorders or disturbances in the functioning of the endocrine system occur. To examine the disturbances and treat them, surgical intervention is needed that come along with complications which are explained in this article.

What Is the Endocrine System?

The endocrine system comprises many glands, which are divided based on their location.

Glands present in the brain include:

• Pituitary gland.

• Hypothalamus.

• Pineal gland.

Endocrine glands present in the neck:

• Thyroid gland.

• Parathyroid gland.

Gland located in the chest:

• Thymus gland.

Glands present in the Abdomen:

• Pancreas.

• Adrenal glands.

What Is Endocrine Surgery?

Endocrine surgeries treat disorders that affect glands in the endocrine system. The surgeries are mostly focused on diseases that affect the thyroid, parathyroid, and adrenal glands. Endocrine glands release hormones into the bloodstream.

Minimally Invasive Surgery - It is a surgical technique that involves less destruction of the surrounding tissues and intricate use of advanced equipment.

One such minimally invasive surgery is explained below

Minimally Invasive Parathyroidectomy (MIP):

The surgery is done along with monitoring the parathyroid hormone. The surgical procedure in the olden era to remove a parathyroid gland (parathyroidectomy) used to require an incision across the neck under general anesthesia and an overnight stay in a hospital. With advancing technology, performing surgery to remove an overactive parathyroid gland (adenoma) is less invasive, quicker, and gives a positive outcome as the standard procedure. Most patients leave the hospital on the same day.

• Robotic surgery is a phase of advancements where doctors monitor surgeries while robots perform surgeries. Robotic surgery obtains the best cosmetic outcome as compared to standard methods. Endocrine surgeries performed by robots include the following:

• Robotic adrenalectomy.

• Robotic thyroidectomy.

• Robotic parathyroidectomy.

What Are the Disorders That Require Endocrine Surgery?

• Acromegaly - Growth hormone production by the pituitary gland can be excessive, making bones grow bigger than normal. Hands, face, and feet are the most affected parts.

• Adrenal insufficiency - The adrenal gland making less level of hormones like cortisol leads to adrenal insufficiency. Cortisol is a hormone that controls stress.

• Cushing's disease - The production of excessive amounts of cortisol in the body leads to Cushing disease. Increase in weight, the appearance of stretch marks. Easily getting bruised, muscle weakness, bone weakness, and developing a hump on the upper back are all the clinical features associated with Cushing's disease.

• Hyperthyroidism - The production of high thyroid hormone levels by the thyroid gland leads to hyperthyroidism. It is also a condition that can be termed an overactive thyroid. Nervousness, loss of weight, and increased heartbeat are a few features of the condition.

• Hypothyroidism - Less production of thyroid hormone than required is called hypothyroidism. Lack of production of the required thyroid hormone makes the body's metabolic system slow down. An increase in weight, slow heartbeat, tiredness, and muscle and joint pains are all symptoms of hypothyroidism.

• Hypopituitarism - A condition in which the pituitary gland does not produce the right amount of hormones and not letting the adrenal and thyroid glands work properly is caused due to hypopituitarism.

• Multiple Endocrine Neoplasia's - Group of disorders affecting the endocrine system is termed multiple endocrine neoplasia's when the disorders are cancers. Tumors are formed on at least two endocrine glands leading to this condition.

• Polycystic ovarian Syndrome - Loss of balance in the production of reproductive hormones creates disturbances during the making of an egg or the release of the egg during ovulation. This leads to irregular periods, hair growth on the face and skin, as well as cause acne.

• Precocious Puberty - Early attainment of puberty in kids whose glands controlling reproduction do not work properly. Most commonly, girls are affected.

What Are the Complications Associated With Endocrine Surgery?

Any complications of endocrine surgery can be categorized under the following interlinked headings.

• Nerve complications.

• Vascular complications.

• Metabolic complications.

Complications associated with surgery of the thyroid and parathyroid gland include the following:

Nerves such as the inferior laryngeal nerve run towards the larynx, close to the thyroid gland. It is a primary motor nerve that provides sensory impulses to the larynx. Injury to this nerve causes paralysis of the vocal cord and various sensory disturbances. Symptoms of this complication include mild to severe hoarseness, airway obstruction, and difficulty swallowing. Even though following the perfect surgical technique and monitoring the neural functions throughout, the occurrence of complications after the surgery still cannot be suppressed, but they can be decreased.

• Hypocalcemia:

Hypocalcemia is the most frequent complication after thyroid surgery. Low levels of calcium in the blood causes hypocalcemia which is a treatable condition. It is usually asymptomatic, but few present with symptoms such as confusion and tingling in fingers and lips, leading to brittle boned. Removal of the complete thyroid gland can cause the highest risk of hypocalcemia.

• Adrenal Surgery:

Complications of adrenal surgery can be classified into the following

• Vascular injuries.

• Organ injuries.

The rate of clinical disturbances occurring with removing the adrenal gland is extremely high, and fatal conditions account for two percent of the total cases. Clinical disturbances can occur due to injury to adjacent structures or infection after the surgery, or adrenal insufficiency. The condition can be fatal if associated with sepsis or a heart c condition (myocardial infarction or arrhythmia). The surgeon follows particular approaches for performing the surgery to limit blood loss.

Pancreatic Surgery:

Pancreatic surgery has been labeled as an intense procedure in previous times. It is now a safe procedure with lower mortality rates. This roadway to categorizing it as a safe procedure is because of centralization. The main contributor to this achievement is the concept of centralization. The surgeon's expertise is important to achieve the success of the treatment and follow a multidisciplinary approach to treatment. The concept of centralization involves pooling surgeons along with dedicated staff to give a proper diagnosis and also manage complications. Octreotide and biliary drainage are adjunctive treatment therapies proven to be beneficial. Following are the complications associated with pancreatic surgery.

• Failed surgery.

• Gastrinoma.

• Insulinoma.

• Pancreatic fistula.

• Abscess.

• Bile and enteric leak.

• Mortality.

Conclusion

Complications of endocrine surgery depend on the type of surgery as well as the clinical condition of the patient. Few complications occur in the early periods, and few others occur in the later stages. Noticing the minor symptom is also necessary, as neglecting it would lead to a more complicated issue. Hence it is necessary to attend all the follow-up appointments and take necessary precautions to avoid complications after endocrine surgery.