[Adrenal tumors]. / Nebennierentumore.

Adrenal tumors Abstract. The term 'adrenal tumor' describes benign and malignant mass lesions of the adrenal gland, including primary adrenal tumors and metastases from extra-adrenal origin. With the widespread use of imaging technique, adrenal tumors have become increasingly detected as 'incidentalomas'. The detection of an adrenal tumor raises two questions: Is the mass malignant? Is the mass hormonally active? Whereas the evaluation for malignancy is based on specific imaging characteristics (imaging phenotype), a targeted clinical examination and specific biochemical tests are required to assess for hormonal secretion. An adrenal mass < 4 cm with clear benign features on imaging and with a normal hormonal workup does not require treatment. If malignancy is suspected further diagnostic procedures and / or adrenalectomy are indicated. For hormonally active tumors surgery is generally considered the treatment of choice; however, the decision for surgery has to be individualized for aldosterone-secreting tumors and for cortisol-secreting tumors with only mild cushing's syndrome. Also in patients with large tumors (> 4 cm), and in cases with non-conclusive evaluation for malignancy or hormonal activity, the decision for further management has to be made on an individual basis. A minimally invasive surgical approach may be considered in adrenal tumors < 6 cm and without local infiltration of adjacent structures. Both laparoscopic (transabdominal) and retroperitoneoscopic techniques are possible. The surgical outcome depends on the surgeon's experience. A close interdisciplinary collaboration is mandatory in the evaluation and treatment of adrenal tumors.

[Primary hyperparathyroidism]. / Primärer Hyperparathyreoidismus.

Primary hyperparathyroidism Abstract. Primary hyperparathyroidism is a common endocrine disease that comes along with a disruption of the calcium homeostasis and is accompanied by a variety of downstream disorders. These are often overlooked as patients present with a multitude of unspecific symptoms or may even be asymptomatic. The diagnosis of primary hyperparathyroidism can be made with the determination of calcium and parathyroid hormone levels, including the measurement of calcium in the 24-hours urine. The operation is the only therapy to cure primary hyperparathyroidism. To successfully conduct focused parathyroidectomy an accompanying visual imaging methodology is of great value and improves the operation success rate. Furthermore, an intraoperative parathyroid hormone monitoring is applied. A bilateral neck exploration technique is applicable in selected cases. The endocrine surgical expertise is pivotal in particular for re-operations, hereditary primary hyperparathyroidism and carcinomas. If surgery is not possible, a medication-based therapy is applied. This medical therapy requests a continuous therapy progress monitoring. In conclusion, to treat primary hyperparathyroidism an interdisciplinary team approach with endocrinologists and endocrine surgeons shows the best results.

Familial nonmedullary thyroid carcinoma-clinical relevance and prognosis. A European multicenter study. ESES Vienna presentation.

PURPOSE: Approximately 5% of differentiated thyroid carcinomas are of familial origin. These familial nonmedullary thyroid carcinomas (FNMTC) have an increased risk of multifocal disease and lymph node involvement. Consequently, higher recurrence rates and decreased disease-specific survival rates are described. The best surgical approach is discussed controversially. PATIENTS AND METHODS: A survey among the international members of the German Society of Endocrine Surgeons revealed 20 families with two or more first-degree relatives with FNMTC. The mean age of the 41 patients (30 female, 11 male) with FNMTC was 40.6 years (18-73 years). RESULTS: Total thyroidectomy was performed in 31 of 41 patients (76%). Ninety-five percent of the tumors were papillary carcinomas. Two of 41 patients had follicular carcinomas. Ten patients (24%) with papillary carcinomas were diagnosed with Hashimoto's thyroiditis. The mean tumor size was 1.45 cm. FNMTC was multifocal in 12 patients (29%). A systematic lymph node dissection was performed in 21 of 41 patients (51%). Lymph nodes metastases were found in seven of these 21 patients. Twenty-eight of the patients (68%) underwent postoperative radioiodine ablation. After a mean follow-up of 7.2 years, 39 patients (95%) were disease free. One patient developed local recurrence and lung metastases, 10 and 25 years, respectively, after initial diagnosis. Another patient died 2 years postoperatively from advanced metastatic disease. CONCLUSIONS: FNMTC is associated with an early onset of small, mostly papillary thyroid carcinomas and an increased risk of multifocality and lymph node involvement. Total thyroidectomy and systematic neck dissection are recommended together with radioiodine ablation. Screening for first-degree relatives should start at age 18 years.