Endocrine surgery Valais Romand Hospital Centre

There are usually four parathyroid glands, located behind the thyroid gland. They are very small (about the size of a lentil) but play a vital role in regulating blood calcium levels through the parathyroid hormone (PTH) they secrete.

The main disorder affecting the parathyroid glands is hyperparathyroidism, which involves excessive production of PTH. This leads to elevated blood calcium levels and can cause:

• Fatigue
• Osteoporosis
• Kidney stones
• Digestive problems

Treatment is usually surgical and involves removing the affected gland or glands.

More rarely, the parathyroid glands may be involved in tumours or structural abnormalities requiring specialist management.

Surgery is indicated in cases of confirmed hyperparathyroidism, particularly if symptoms or complications are present. It helps restore normal calcium levels and brings about a lasting improvement in quality of life.

The adrenal glands are two small endocrine glands, each situated above a kidney. They play a vital role in regulating many vital functions through the production of hormones, including

• Cortisol (a stress response hormone)
• Aldosterone (a hormone that regulates fluid balance and blood pressure),
• Catecholamines (hormones regulating blood pressure and metabolism)
• Sex hormones.

These hormones are involved in regulating blood pressure, fluid and electrolyte balance, glucose metabolism and the stress response. A single adrenal gland is sufficient to ensure the body functions normally.

Adrenal surgery is indicated when a tumour is discovered in the gland, such as:

• A secreting adenoma,
• A pheochromocytoma (a tumour producing catecholamines)
• More rarely, an adrenal cortical carcinoma (cancer).

These lesions can lead to excessive hormone production, causing symptoms that are sometimes severe and potentially serious complications.

Surgery can then correct this imbalance and prevent complications.

Removal of the adrenal gland may also be necessary in the case of a large lesion or when malignancy is suspected. Although malignant adrenal tumours are rare, surgical management is essential to limit complications and improve the prognosis.

Gastrointestinal neuroendocrine tumours are rare tumours arising from neuroendocrine cells, found in various organs of the gastrointestinal tract and the respiratory system. They share common morphological and functional characteristics, notably the expression of specific markers and, in some cases, the ability to produce hormones.

These tumours are characterised by a wide variety of locations, growth patterns and hormonal secretions, which explains the need for a multidisciplinary approach combining surgery, oncology, gastroenterology and endocrinology.

They can be found in:

• The small intestine
• The pancreas
• The colon and rectum
• More rarely, the lung

Although rare, with an estimated incidence of around 5.25 cases per 100,000 inhabitants, their diagnostic frequency has increased over recent decades, largely due to improvements in imaging and diagnostic techniques. Their progression, which is often slower than that of other digestive cancers, also explains their growing prevalence.

Treatment depends on the location, extent and functional nature of the tumour. Endocrine surgery plays a central role when the tumour is localised and resectable. In such situations, it allows for curative treatment or tumour and hormonal control, in addition to other therapeutic approaches.