What's new in general surgery: endocrine surgery.

Abstract

t t c n a t t c C p d C c o drenal n 1911, Dr Harvey Cushing said, “I would like to see he day when somebody would be appointed surgeon omewhere who had no hands, for the operative part is he least part of the work.” In no area of endocrine urgery is this more true than in the diagnostic workup nd surgical planning of patients with adrenal patholgy. The past year saw the publication of a consensus onference on diagnosis and treatment of Cushing’s synrome. Although only 20% of Cushing’s syndrome paients have ACTH-independent Cushing’s resulting rom an adrenal source, the article provides an excellent onsensus statement on the diagnostic criteria needed in he workup of these complex and often challenging atients. Another important area for the endocrine surgeon is he laboratory diagnosis of pheochromocytomas. Auhors from the Mayo Clinic compared their experience efore the use of fractionated, plasma-free metanephrine 1978 to 1996) with current data obtained after the ntroduction of such testing. Plasma metanephrines ad a sensitivity of 96%, yet a specificity of only 85%. heir experience demonstrated that biochemical testing or pheochromocytomas should be directed by the deree of clinical suspicion. Fractionated, plasma-free etanephrines were ideal in patients with a high pretest robability of the disease, such as familial patients MEN IIa, IIb, von Hippel-Lindau [VHL], neurofibroatosis type 1, or familial paraganglion syndrome) or atients in whom urinary collection is problematic (peiatric population). In the more common scenarios, hose with incidentalomas, or patients with poorly con-