For Referring Physicians - Surgical Unit focus
UCLA Endocrine Surgical Unit treats thyroid, parathyroid and adrenal disease
The UCLA Endocrine Surgical Unit focuses on the treatment of adult
and pediatric patients with disorders of the thyroid, parathyroid and adrenal glands.
These common conditions, which
affect women in disproportionate numbers, are treated at UCLA in a highly specialized program.
Within the full spectrum
of care availiable at UCLA, the Endocrine Surgical Unit focuses on achieving a high volume
of cases in its
specialty area. Recent research strongly supports the idea that the hospitals and surgeons
who perform the highest volume of a given procedure achieve the lowest rates of post surgical
complications and the best outcomes.
Thyroid disease
Thyroid nodules – or lumps in the thyroid – are present in 4 to 7 percent
of the adult population. Less
than 5 percent of these will prove to be malignant; a needle biopsy can be used to differentiate
between
benign and malignant tumors in most cases. Patients diagnosed with either overtly malignant
or suspicious
nodules can be referred to the UCLA Endocrine Surgical Unit for treatment. Biopsy specimens
are
routinely reviewed by a team expert as a second opinion before surgical treatment is considered.
Patients
with Graves Disease, a form of hyperthyroidism, who have symptoms such as eye or skin disease
or who cannot tolerate medication for their condition are also candidates for thyroid surgery.
Pregnant
women or those desiring pregnancy may also seek a rapid surgical solution to their disease
process.
Parathyroid disease
The parathyroid glands — four small glands located on the back side of the thyroid
gland — control the
body’s calcium levels. Parathyroid disease affects approximately 1 percent to 2 percent
of the population.
The chances of parathyroid disease increases with age, particularly after the age of 55.
Elevated calcium
levels are typically detected on routine blood testing, with more than half of cases due
to a parathyroid
tumor. These tumors also play a role in cardiovascular disease, bone loss and neuropsychiatric
functioning.
Surgery to remove one or more abnormal parathyroid gland is now recommended by
national expert groups
for all patients diagnosed with primary hyperparathyroidism, and is more than 98 percent
successful in
experienced hands. Minimally invasive parathyroidectomy may be an option for the roughly
85 percent of
patients whose disease is caused by a single abnormal grand. After a parathyroid sestamibi
scan and
ultrasound establish that only one parathyroid gland is involved, the patient can be treated
through a twocentimeter
incision in a procedure that typically takes less than one hour.
Adrenal disease
The two adrenal glands, located on top of the kidneys, make an array of hormones that
includes
glucocorticoids, mineralocorticoids, sex steroids, and adrenaline and related compounds.
Patients with
adrenal tumors may present with hypertension. A significant fraction of “essential” hypertension – currently
estimated as approximately 3 percent of patients whose hypertension is without a recognized
and
correctable cause – may be due to hormonally active adrenal tumors, such as aldosterone-producing
adenomas. Once identified, these patients can be treated and cured of their hypertension.
Pheochromocytoma
is a tumor that releases adrenaline and other potent compounds that dangerously increase
blood pressure. The recent discovery of new germline mutations causing pheochromocytoma has
led to the finding that up to 25 percent of cases are part of a familial syndrome. UCLA screens
all patient
family members and offers genetic counseling in an effort to identify affected individuals
before their health
is threatened by advanced tumors.
Widespread use of CT (computed tomography) scanning has
led to the increased detection of adrenal
'incidentalomas' — adrenal masses discovered during an imaging procedure performed
for unrelated
reasons. The National Institutes of Health (NIH) recommends that a battery of blood and urine
tests for
excessive hormone production be performed for all patients with incidentally discovered adrenal
masses.
These tests look for elevated levels of glucocorticoids, mineralocorticoids, and adrenaline
and related
compounds. Surgery is recommended for patients whose tests return positive results, and for
patients with
negative test results but with tumors greater than six centimeters. Patients with tumors
greater than four
centimeters should also be considered for surgery if they are otherwise in good health.
Most
adrenal lesions can be treated laparoscopically in a procedure that lasts less than two hours
and calls for only a 23-hour hospitalization. Laparoscopic surgery decreases pain and recovery
time and has produced
excellent results at UCLA.
Contact information
For more information, for consultation, or to refer a patient, call:
- 310-206-0585 Primary line for information and appointment scheduling
- 310-825-8340 Secondary
line
- 310-825-0189 Fax
Participating physicians
The Endocrine Surgical Unit at UCLA involves physicians from a
number of specialties. The team members include:
Michael Yeh, M.D. – Endocrine Surgery, Director
Jianyu Rao, M.D. – Pathology and Laboratory Medicine
Sharon Hirschowitz, M.D. – Pathology and Laboratory Medicine
Nagesh Ragavendra, M.D. – Radiological Sciences/Ultrasound
Jacqueline Casillas, M.D. – Pediatric Hematology/Oncology
Christiaan Schiepers, M.D. – Molecular and Medical Pharmacology.
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