The Oregon Clinic - Oregon Endocrine Surgery

About

A Multidisciplinary Approach

The Oregon Endocrine Surgery Center is dedicated to treating conditions that affect the thyroid, parathyroid, and adrenal glands. Our center uses a multidisciplinary approach to diagnose and treat endocrine diseases. Both the evaluation and treatment of these disorders are fairly complex and best done at centers with extensive experience.

What Makes Our Approach Different: At the Oregon Endocrine Surgery Center, we use a patient-centered approach that provides individualized treatment and focus for each patient. Our interdisciplinary team is comprised of doctors that specialize in the diagnosis and treatment of endocrine diseases. They use state-of-the-art diagnostic tools, including advanced imaging and laboratory tests, to accurately locate and stage the disease. Appropriate and whenever possible the least invasive surgical management is offered to the patient. Postoperative follow-up and therapy to reduce disease recurrence and increase detection is emphasized. Having a team of experts on your side is your best defense when fighting disease.

"Having a team of experts on your side is your best defense."

 

What to Expect

Thyroid Imaging

Thyroid ultrasound is considered the primary imaging tool for evaluating the thyroid gland. This examination is performed most commonly when a physician feels an abnormality, such as generalized thyroid enlargement or a focal nodule, or when the patient has complaints of difficulty swallowing or a feeling of fullness in the neck.

Thyroid ultrasound is a painless procedure and uses no radiation. During the procedure, the patient lies on a comfortable table with his or her neck slightly extended. The ultrasound technologist uses a transducer coated with gel to scan over the thyroid gland and obtain a series of standard images. Both lobes are measured, and any nodules that are seen are measured. Color Doppler ultrasound is utilized to help determine the vascularity of the gland as a whole, as well as any focal abnormalities.

The exam takes 15 to 45 minutes to complete, depending on the number of nodules.  The radiologist spends time evaluating the information obtained by the sonographer and compares the findings to any prior examinations. Although ultrasound cannot definitely differentiate benign from cancerous nodules, there are a number of features that the radiologist uses to help determine whether a biopsy is needed. Features of a nodule that increase the likelihood of cancer include irregular shape, a large proportion of solid tissue and not entirely cystic, calcifications within the nodule, and increased vascularity.

Based on these observations, the radiologist then generates a report to the referring clinician. Often, the radiologist will then make recommendations for follow-up imaging or for fine needle aspiration/biopsy.

 

Thyroid Biopsy

When it is determined that a nodule or nodules in the thyroid are concerning for cancer, the next step is to obtain tissue from the thyroid for evaluation by a pathologist. The procedure of choice for obtaining a sample of tissue from a thyroid nodule is called a fine needle aspiration, or FNA, which is an extremely safe, minimally invasive biopsy procedure. This is typically performed by a radiologist using ultrasound guidance to help target the abnormal area.

The FNA procedure takes about 30 to 60 minutes, depending on the number of nodules being sampled. The radiologist will explain the procedure to the patient, including the risks of FNA. These include mild pain at the biopsy site and the potential for bleeding and infection. In a small percentage of cases, the pathologist is unable to make a definite diagnosis based on the FNA, which may lead to either follow-up imaging or a surgical biopsy.

The procedure is performed with the patient lying comfortably on a table, with their neck slightly extended. In the procedure room, the radiologist is assisted by an ultrasound technologist who assists with various instruments used for the FNA and operates the ultrasound machine for the radiologist.

To do the FNA, the radiologist scans the neck with the ultrasound probe and places a mark at the skin entry site for the needle. This area is cleaned with an antibacterial solution, and then a local anesthetic such as lidocaine is administered. Next, several samples are obtained from the nodule or nodules.

Typically, anywhere from one to four nodules may be sampled at each visit. while your wait, a cytotechnologist looks at the biopsied material under a microscope to determine if enough cells have been obtained for the pathologist to make a diagnosis. The final report is typically available in 2 or 3 days.

Symptoms after the procedure are generally mild and may consist of slight tenderness and bruising at the biopsy site. There are no restrictions on activities after the procedure.

 

Thyroid Cancer Imaging

Thyroid tissue is the only type of tissue that uses Iodine in the body. For this reason, radioactive Iodine plays a role in both the imaging and treatment of thyroid cancer. When the thyroid gland is surgically removed, the surgeons often leave behind some thyroid tissue in their efforts to protect other essential structures in the anterior neck. The thyroid scan is used to determine the amount of residual thyroid tissue left behind after surgery, or to identify any new sites of thyroid cancer that may have developed since the previous imaging study.

Preparing for this type of imaging takes several weeks, and special instructions will be given to you by your endocrinologist and the nuclear medicine scheduler. The day before imaging, you are asked to come to the nuclear medicine department to receive the molecular tracer by mouth. Twenty-four hours later, we acquire images of your entire body while you are resting on an imaging table and the imaging camera moves along your body. A separate measurement of your neck is made while sitting in a chair. The entire imaging session takes approximately 2 hours.

 

Thyroid Cancer Treatment

The imaging described in Thyroid Cancer Imaging is sometimes followed by treatment with a different kind of radioactive iodine, which releases energy to kill the thyroid tissue. The decision as to which patients with thyroid cancer benefit from this additional treatment is made by your team of physicians. The treatment is given by mouth and requires a meeting with the radiologist to explain specific radiation precautions. If specific conditions are not met in your home, this treatment may require hospitalization for 2-3 days.

Thyroid scans are also quite helpful for surveillance of cancer recurrence. Your endocrinologist and our endocrine radiologists will coordinate this aspect of your care at regular follow up intervals after surgical removal of your thyroid cancer.

 

Parathyroid Imaging

The parathyroid scan is the best non-invasive method for identifying the location of an abnormal parathyroid gland. Most abnormal parathyroid glands are located in the anterior neck, around the thyroid gland, but can occasionally be found in the chest.

On the day of imaging, you should come prepared to spend up to four hours in the Diagnostic Imaging department. Once the molecular tracer is injected into the vein, you will be resting comfortably on an imaging table while the imaging camera moves around you. Several nuclear medicine images are acquired over a period of 3 hours. This procedure is painless.

Most patients also require an ultrasound to confirm the position of the abnormal gland. This technique is safe and uses no radiation. On rare occasions, additional imaging with CT or MRI may be required preoperatively.

 

Adrenal Imaging

The role of the radiologist is particularly valuable in the diagnosis and treatment of the adrenal glands. From a diagnostic perspective, state of the art CT and MRI imaging can provide detailed information about the anatomy of the adrenal glands. These examinations can show benign or malignant tumors in exquisite detail. MRI has the added benefit of providing information about chemical content in the cells of tumors that are discovered. If a biopsy is indicated, CT scans allow the Interventional Radiologist to sample a tumor with extreme precision, making the procedure both safe and accurate.

Interventional Radiologists, with their technical skills using catheters and other medical devices, can be essential members of the endocrine medical team. Using minimally invasive techniques and imaging guidance, these specialized physicians compliment the care of the endocrine patient in areas of diagnosis and treatment. For example, micro-catheters can be directed into the veins draining an adrenal gland suspected of over-producing or under-producing a particular hormone. Samples of the vein blood can be obtained and then analyzed for specific adrenal hormones.

 

FAQ

The Endocrine System

The Endocrine system is a complex collection of glands and organs that produce and secrete hormones directly into the bloodstream. The hormones secreted influence and control functions of the body such as metabolism, calcium regulation, growth and development, and sexual function.

There are a number of conditions and diseases that can affect the endocrine system. Some of the diseases affecting the endocrine system happen because of inappropriate hormone production; while others are the result of an abnormal mass or tumor in the specific organ.

The team at the Oregon Endocrine Surgery Center diagnose and treat diseases that affect the adrenal, thyroid and parathyroid glands and can help you on the road to recovery.

For additional patient information about the endocrine system, visit endocrinediseases.org

Thyroid Disease

Thyroid disease will affect 27 million Americans each year. More than half of people living with thyroid disease go undiagnosed. Thyroid disease affects almost every aspect of health, so understanding more about the thyroid, and the symptoms that occur when something goes wrong with this small gland, can help you protect or regain good health.

The Thyroid is a gland that controls key functions of your body. Disease of the thyroid gland can affect nearly every organ in your body and harm your health. Women have a seven times increased risk for developing thyroid problems. A woman faces as high as a one in five chance of developing a thyroid disorder during her lifetime. This risk increases with age and for those with a family history of thyroid problems. In most cases, treatment of thyroid disease is safe and simple.

Thyroid Gland

THE THYROID GLAND is a butterfly-shaped organ located in the center of the neck. It secretes a hormone that is responsible for multiple facets of daily life including maintenance of energy, temperature, weight, and metabolism. Symptoms of thyroid disease generally result from either over or underproduction of thyroid hormone, growth of potentially cancerous nodules or generalized overgrowth of the entire gland causing compression of surrounding structures in the neck.

Hormone Imbalance

The thyroid gland can over or under produce thyroid hormone. Symptoms of hyperthyroidism (excessive thyroid hormone) include tremors, palpitations (racing heart), trouble sleeping, heat intolerance, weight loss, hair thinning, nervousness, irritability, muscle weakness and abnormal menstrual cycle. Symptoms of hypothyroidism (inadequate thyroid hormone) include lethargy, weakness, cold intolerance, dry skin, depression, constipation, forgetfulness, weight gain, joint pain, and abnormal menstrual cycle. The majority of patients affected with these conditions are treated with medication. Certain patients with inappropriately high thyroid hormone levels benefit from surgical intervention.

Thyroid Goiter

Goiter is a term that describes an enlarged thyroid gland. Iodine deficiency is the most common cause of goiter around the world; however, Hashimoto’s thyroiditis accounts for the majority of the cases in this country. Other causes of goiter include multiple nodules, Graves’ Disease and tumors which can be benign (non-cancerous) or cancerous. Patients may be referred for surgical evaluation if the thyroid gland has enlarged to the point of causing compression of surrounding structures. Those affected may experience a choking sensation, hoarseness, wheezing and swallowing difficulty.

Thyroid Nodule

A thyroid nodule is any abnormal growth of thyroid tissue into a lump. It is often diagnosed on clinical examination or noted on ultrasound. The nodule can be solid or fluid-filled (cyst), solitary or multiple. The vast majority of thyroid nodules are benign, but some can harbor thyroid cancer (<10%). Furthermore, most thyroid nodules are asymptomatic but others can cause symptoms based on size, location, and excessive thyroid hormone production. Depending on its size or characteristics, some nodules will require a biopsy. This is often accomplished by first numbing the skin overlying the nodules and then obtaining some sample cells with a small needle. This procedure is minimally invasive and is often performed under the guidance of ultrasound to increase the accuracy. The result of the biopsy will guide further management.

 

Thyroid Cancer

Thyroid cancer is a relatively rare form of cancer involving the thyroid gland. It accounts for only about 1.5% of new cancer diagnoses in the US; however, over the last three decades, the incidence of thyroid cancer has been steadily increasing. There are certain risk factors such as a history of neck irradiation, exposure to external sources of radiation and a family history of thyroid cancer that are associated with thyroid cancer. Physical exam and ultrasound are the primary tools to evaluate the thyroid gland; while blood tests have limited utility. Suspicious masses in the thyroid can be readily sampled or biopsied with a small needle. Some cancers of the thyroid are hard to differentiate from non-cancerous changes based on this needle biopsy and may ultimately require surgical removal of all or part of the gland in order to properly diagnose the presence of thyroid cancer. 

There are four subtypes of cancer that arise from the thyroid gland itself. In addition, rarely lymphoma or cancers from other areas in the body can spread to the thyroid gland. More than 80% of thyroid cancers are papillary. This is generally a low grade, slowly spreading cancer that is often successfully removed with surgery. Additional treatment is sometimes indicated depending on the extent and characteristics of the tumor. Lymph node removal and or administration of radio-iodine to treat residual microscopic disease are among these therapies. Follicular cancer represents about 10% of primary thyroid cancers and can spread to others areas in the body in about 10-30% of patients. Treatment is generally limited to surgical removal of the thyroid. Medullary cancer, which can be hereditary accounts for less than 10% of thyroid cancers and can be associated with other abnormalities of the endocrine system. Anaplastic cancer is a very rare form that generally occurs in older patients. Treatment involves radiation, chemotherapy and surgery. As with most cancers, a team of specialists are usually involved in diagnosis and comprehensive treatment of thyroid cancer. The goal is to eradicate the cancer and minimize the risk of recurrence.

Thyroid Surgery

The extent of thyroid surgery may vary based on the size and number of thyroid masses. Your surgeon may recommend partial or total removal of the thyroid gland. This surgical procedure is generally done under general anesthetic to optimize your comfort and safety. A small incision is made low in the neck. Once the underlying muscles are retracted, the thyroid gland is exposed. Prior to its removal, the structures surrounding the thyroid gland (blood vessels, nerves, parathyroid glands and lymph nodes) are carefully examined, both to assess any abnormalities and to minimize the risk of injury. Careful surgical dissection allows removal of the diseased portion or the entire gland. A microscopic review of the removed portion will guide future treatment such as additional surgery, radio-iodine therapy and thyroid medication. Some patients may be discharged the same day; while others require an overnight hospital observation.

Risks of Thyroid Surgery

Thyroid surgery is safe and in appropriately selected patients can have significant benefits. However, any operation has some general and specific risks. The general risks of this surgery include a reaction to the anesthetic, prominent scar, wound infection, and blood clots. The more specific risks include:

  1. Bleeding: Bleeding following surgery is rare but can result in a clot in the neck tissue which can, in turn, put pressure on the windpipe. This can lead to difficulty breathing and is treated with a second operation to remove the clot.
  2. Low Calcium Level (Hypocalcemia): Some patients can experience a drop in their blood calcium below levels that are normal following surgery. This is usually treated with calcium tablets and typically improves with time. In extremely rare situations, all 4 parathyroid glands are inadvertently removed with the thyroid permanent hypocalcemia can result in lifelong need for calcium supplementation.
  3. Voice Hoarseness: Some patients may experience hoarseness or changes in the caliber of their voice following surgery. In the majority of cases, this is a temporary event. However, in 1-2% of cases, injury to the recurrent laryngeal nerve results in permanent voice changes. Additional surgery or speech therapy can be helpful in some cases.
  4. Loss of Airway: If the nerves supplying both vocal cords is injured during the surgery, this can lead to a blockage of the breathing tube requiring the need for a tracheostomy (an artificial airway created through the neck). This event is exceedingly rare and occurs in less than 1% of cases.

After Surgery Instructions

After surgery, many patients will be able to go home the same day or the following morning. Recovery is fairly quick and the procedure causes little discomfort. Patients usually resume normal activity within a couple days and some patients return to work within days of the surgery.

Diet: You may experience some decrease in your appetite, nausea and occasionally vomiting. Therefore you may do better with light meals for the first 24-36 hours following surgery.

Activity: Do not engage in potentially hazardous work or make important personal or business decisions if taking pain medications. Do not drive until narcotics are no longer required for pain control.

Elevate the head whenever possible. When sleeping use 2-3 pillows if possible. We recommend that patients avoid driving until they are comfortable moving their neck in all directions and until they are OFF narcotics.

Wound: Leave butterfly strips in place if present. You may notice some bruising around incision or below your scar. You may shower 24 hours following surgery. Avoid baths for 2 weeks. No special ointments or creams are required.

The scars are usually hidden in natural skin folds in the neck and usually heal well becoming less pronounced with the passage of time.

Medication: Take pain medication and any supplements as instructed. Keep in mind that pain medications can sometimes cause nausea and are better tolerated if taken with some food. If you develop constipation, you may use over the counter stool softeners such as Surfak or Dulcolax 1-2 times daily. Please contact your pharmacy to obtain a refill. We can work directly with them to expedite the prescription. We are unable to refill medications on the weekend.

Take pain medication, calcium/vitamin D supplements and thyroid replacement if applicable as instructed. If you develop numbness or tingling around your mouth or fingertips, take 2 additional calcium pills and contact your physician as this may represent a sign of low calcium levels.

Follow Up: Please schedule an appointment to see your surgeon 2 weeks following surgery. If necessary, you should also get your calcium and parathyroid hormone levels checked within 6 month of the surgery. If on thyroid replacement therapy, a blood test will be checked by your surgeon or endocrinologist in a few weeks to ensure appropriate dosage. Call the office at 503.963.2935 and our staff will be happy to make the necessary arrangements for you.

 

Parathyroid Disease

The parathyroid glands secrete parathyroid hormone that helps maintain your body's correct balance of calcium by regulating the release of the calcium from bone, absorption of calcium in the intestine, and excretion of calcium in urine. Parathyroid disease will affect about 100,000 Americans each year. More than half of people living with parathyroid disease go undiagnosed due to the vagueness of symptoms and difficulty in diagnosis.

Parathyroid Glands

THE PARATHYROID GLANDS are four small glands located in the neck that are responsible for controlling the calcium level in our blood. Despite the name similarity, the thyroid and parathyroid glands are not the same and serve very different functions. Problems with the parathyroid glands do not translate into problems with the thyroid gland which is under a different type of control.

The most common problem affecting the parathyroid glands is hyperparathyroidism (HPT), when one or more of the glands become too active and no longer follow the normal body signals to shut down the production of parathyroid hormone. As a result, the calcium level in the blood will rise and can affect many of the internal organs such as bones, muscles, kidneys, gastrointestinal tract, and even memory and mood.

Hyperparathyroidism or elevated parathyroid hormone is most often caused when one gland is enlarged because of a noncancerous growth (adenoma). In the minority of cases, more than one gland can be diseased. Parathyroid cancer is very rare and accounts for only 1% of hyperparathyroid cases. Hyperparathyroidism is a very treatable problem and surgical removal of the abnormal gland or glands is the only curative treatment.

Symptoms of Hyperparathyroidism

It is common for patients with hyperparathyroidism not to know that they are affected.  This is because the signs are usually very mild and vague.  Patients often attribute these symptoms to other health reasons or life stressors.  Some patients may experience the following:

  • Depression
  • Difficulty concentrating
  • Forgetfulness
  • Constipation
  • Abdominal pain
  • Excessive thirst
  • Excessive urination
  • Kidney stones
  • Joint or bone pain
  • Muscle weakness
  • Bone loss
  • Broken bone

Diagnosis of hyperparathyroidism

The diagnosis of hyperparathyroidism is often made by a blood test that examines your blood for calcium, parathyroid hormone, and vitamin D levels.  In addition, once the diagnosis is made, your doctor may choose to do additional studies to determine whether some of your most commonly affected organs have been involved.  This may include a urine sample to test whether there has been any damage to the kidneys.  Along the same lines, a bone density study can show whether having had hyperparathyroidism has affected your bone health. The bony areas most often tested are hips, lower back, and forearm.

 

Treatment of Hyperparathyroidism

Surgery is the only cure for primary hyperparathyroidism. The vast majority of our patients are candidates for minimally invasive or focused parathyroidectomy. This process is initiated by localizing the abnormal gland with specialized imaging by one of our dedicated endocrine radiologists. Once this is accomplished, a focused exploration of the neck through a less than one inch incision is performed and the abnormal gland is removed. This often eliminates the need for a more extensive surgery involving exploration of both sides of the neck. In addition, this technique offers a more aesthetic incision, a shorter operating time and a lower incidence of postoperative hypocalcemia. The procedure is most often performed with a combination of local and general anesthetic to optimize patient comfort and safety. In appropriately selected patients, minimally invasive parathyroidectomy can often be performed as an outpatient.

 

Risks of Parathyroid Surgery

Parathyroid surgery today is safe and in appropriately selected patients can often be performed in a minimally invasive manner. However, any operation has some general and specific risks. The general risks of surgery include reaction to the anesthetic, scar, wound infection and blood clots.  The more specific risks include:

  • Bleeding:  Bleeding following surgery is rare but can result in a clot in the neck tissue which can, in turn, put pressure on the windpipe.  This can lead to difficulty breathing and is treated with a second operation to remove the clot.
  • Low calcium level (Hypocalcemia):  Some patients can experience a drop in their blood calcium below those that are normal following surgery.  This is usually treated with calcium tablet and typically improves with time.
  • Persistent high calcium level (Hypercalcemia):  In less than 5% of patients, the abnormal gland cannot be identified even by an experienced surgeon. This results in continued hyperparathyroidism.  Furthermore, even after successful surgery, some patients can develop disease in another one of their glands leading to recurrence of their disease.
  • Voice hoarseness:  Some patients may experience hoarseness or changes in the caliber of their voice following surgery. In the majority of cases, this is a temporary event.  However, in 1-2% of cases, injury to the recurrent laryngeal nerve results in permanent voice changes. Additional surgery or speech therapy can be helpful in some cases. In patients who are public speakers or professional singers, subtle changes may result from this type of operation.

 

After Surgery Instructions

After surgery, many patients will be able to go home the same day or the following morning. Recovery is fairly quick and the procedure causes little discomfort. Patients usually resume normal activity within a couple days and some patients return to work within days of the surgery.

Diet: You may experience some decrease in your appetite, nausea and occasionally vomiting.Therefore you may do better with light meals for the first 24-36 hours following surgery.

Activity: Do not engage in potentially hazardous work or make important personal or business decisions if taking pain medications. No driving until narcotics are no longer required for pain control is advisable.

Elevate the head whenever possible. When sleeping use 2-3 pillows if possible. Most patients can resume normal activity within a couple of days of the surgery. We recommend that patients avoid driving until they are comfortable moving their neck in all directions and until they are OFF narcotics.

Wound: Your bandage may be removed 24 hours after surgery, but leave butterfly strips in place. You may notice some bruising around incision or below your scar. Avoid baths, but you may shower 24 hours following surgery.

The scars are usually hidden in natural skin folds in the neck and usually heal well becoming less pronounced with the passage of time.

Medication: Take pain medication and supplements as instructed. Keep in mind that pain medications can sometimes cause nausea and are better tolerated if taken with some food. If you develop constipation, you may use over the counter stool softeners such as Surfak or Dulcolax 1-2 times daily. We are unable to refill medications on the weekend. Please call your pharmacy to obtain a refill. We can work directly with them to expedite the prescription.

The month following surgery, patients will take calcium with Vitamin D, until the remaining parathyroid glands have regained their normal function. If you develop numbness or tingling around your mouth or fingertips, take 2 additional calcium pills and contact your physician as this may represent a sign of low calcium levels.

We are unable to refill medications on the weekend, please call during office hours Monday-Friday 9:00-4:00 pm.

Follow Up: Please schedule an appointment for a post-operative exam 2 weeks following surgery. You should also get your calcium and parathyroid hormone levels checked 6 month following surgery. Call the office at 503.963.2910 and our staff will be happy to make the necessary arrangements for you.

 

Adrenal Disease

Adrenal disease occurs when there is an overproduction of any of the adrenal hormones or when a tumor, cancerous or benign, grows within the adrenal gland. It is believed that genetic abnormalities may predispose some people to certain adrenal tumors, but the majority of these tumors have no known cause. There are a number of disorders that can affect the adrenal glands. Most adrenal glad tumors are non-cancerous adenomas that usually do not cause symptoms and may not require treatment.

Adrenal Tumors

A tumor begins when normal cells change and grows abnormally, forming a mass. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to or from other parts of the body).

An adrenal gland tumor can sometimes overproduce hormones. When it does, the tumor is called a functioning tumor. An adrenal gland tumor that does not produce hormones is called a non-functioning tumor. The symptoms and treatment of an adrenal gland tumor depend on whether the tumor is functioning or non-functioning, and what hormone(s) is overproduced.

Adenoma is the most common type of adrenal gland tumor. It is a noncancerous tumor that usually does not cause symptoms, and, if it is small, often does not need treatment.

Excess Hormone Secretion

Adrenal Gland tumors can oversecrete hormones causing various syndromes:
 
Conn’s Syndrome is the overproduction of aldosterone by a tumor in the adrenal gland. Many of these patients have had longstanding high blood pressure which has been difficult to control along with low potassium levels on their routine blood test. Their symptoms are often vague and may include headaches, fatigue, muscle weakness, thirst and frequent urination. 

Cushing’s Syndrome occurs with overproduction of cortisol from the adrenal gland. Those affected develop high blood pressure and even diabetes. These patients are often obese particularly in the center of their body and have round faces described as moon facies. They may suffer from depression, weakness, easy bruisability and skin changes that may include excess hair growth or purple stripe like discoloration. 

Pheochromocytoma results when there is overproduction of epinephrine, norepinephrine or dopamine. Ten percent of these tumors are cancerous, 10% are hereditary and 10% can occur in both adrenal glands. Patients may suffer from “spells” of markedly high blood pressure, sweating, racing heart, headache and a feeling of anxiety. Variations to these symptoms are not uncommon. Adrenal tumors secreting sex hormones described as virilizing or feminizing tumors are exceedingly rare. They are seen in some women with excess hair growth and irregular menses. Men can suffer from impotence, loss of libido and enlarged breasts.

Adrenal Cancer

Cancer of the adrenal gland itself is extremely rare and occurs in about one person per million in this country. It accounts for less than 5% of adrenal tumors. Adrenocortical carcinoma can be a functioning or non-functioning tumor. If the tumor is functioning, it may produce one or more hormone. A tumor can start in an adrenal gland (called a primary adrenal tumor) or it can begin in another organ, such as the lungs, and then metastasize (spread) to the adrenal glands. General symptoms include fever, abdominal pain, weight loss and a mass that you can feel. Increased hormone levels can cause an increase in heart rate, potentially high blood pressure and blood sugar, excess hair growth,bruising, increased thirst and frequent urination.

Diagnosis of Adrenal Tumors

With more widespread use of imaging studies, it has become increasingly common for adrenal tumors to be detected. In fact, up to 5% of CT scans of the abdomen obtained for various reasons, including abdominal pain, demonstrate an “incidental” adrenal mass. Once discovered, it is important to establish whether there are characteristics that are suspicious for cancer. In addition, hormonal studies are performed by collecting blood and or urine samples. In certain cases, a procedure called adrenal vein sampling may be necessary to make the definitive diagnosis. Our approach is to work as a team of doctors including surgeons, radiologists, medical endocrinologists and nephrologists to arrive at the correct diagnosis. Input from the patient’s primary care physician is certainly valued and included in this evaluation.

Treatment

Once the appropriate diagnosis is made, recommendations regarding observation with follow up, treatment with medication or surgical intervention will be made. The majority of patients requiring removal of their adrenal tumor are candidates for minimally invasive surgery using laparoscopy. This procedure is performed under general anesthetic and 3-4 small incisions, each measuring ¼ to ½ inch, are made for introduction of a camera and miniature instruments for removal of the abnormal gland. Patients may often be discharged from the hospital the day following the procedure. Rarely an open technique is required for the removal of the diseased gland. Depending on the indication for adrenalectomy, it is often necessary to have certain factors such as the blood pressure monitored closely postoperatively. The full effect of the operation on alleviating symptoms is not always immediately apparent and changes in medication will need to be made with the assistance of other specialists.

Risks of Adrenal Surgery

Adrenal surgery is safe and in appropriately selected patients can often be performed in a minimally invasive manner. However, any operation has some general and specific risks. The general risks of this surgery include a reaction to the anesthetic, scar, wound infection, and blood clots. The more specific risks include:

  1. Bleeding: Bleeding following surgery is rare, but can occur. In the event that it does, a transfusion or rarely a second operation may be required.
  2. Injury to Surrounding Structures: The adrenal glands are surrounded by very important and delicate structures including major blood vessels, colon, pancreas, spleen and stomach. Obviously the utmost care is taken during the procedure to keep these other vital organs safe; however, even in experienced hands an injury may occur. If recognized at the time of the original operation, a repair can be performed, but sometimes a re-operation becomes necessary.
  3. Persistent Symptoms: Some symptoms such as high blood pressure in patients with adrenal tumors can be caused by multiple factors. Removing the diseased adrenal gland can certainly eliminate the contribution of hormonal over-secretion; however, the other causes of high blood pressure may persist. It is common for patients to still require some medication for treatment of their blood pressure following surgery. Furthermore, in rare cases, patients can have recurrence of their disease in the other adrenal gland leading to similar symptoms.

After Surgery Instructions

After surgery, most patients will be able to go home the following day. Recovery is variable, but patients usually resume normal activity within a few days. Some patients return to work within a week or two of the surgery.

Diet: You may experience some decrease in your appetite, nausea, and occasionally vomiting. Therefore, you may do better with light meals for the first 24-36 hours following surgery.

Activity: Do not engage in potentially hazardous work or make important personal or business decisions if taking pain medications. Do not drive until narcotics are no longer required for pain control.

Most patients can resume normal activity within a few days of the surgery. We recommend that patients avoid heavy lifting over ten pounds for about 3 weeks.

Wound: Leave butterfly strips in place if present. You may notice some bruising around incision or below your scar. You may shower 24 hours following surgery. Avoid baths for 2 weeks.

Medication: Take pain medication and supplements as instructed. Keep in mind that pain medications can sometimes cause nausea and are better tolerated if taken with some food. If you develop constipation, you may use over the counter stool softeners such as Surfak or Dulcolax 1-2 times daily. Please contact your pharmacy to obtain a refill. We can work directly with them to expedite the prescription. We are unable to refill medications on the weekend.

Please Contact Our Office: If you develop fever over 100.5F or 38.5C, increasing abdominal pain, persistent nausea, calf or leg swelling, shortness of breath or any other problems.

Follow Up: Please schedule an appointment for a postoperative evaluation in 2 weeks unless instructed otherwise. Call the office at 503.963.2935 and our staff will be happy to make the necessary arrangements for you.

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Research & Education

Our philosophy of comprehensive and expert care delivered in a minimally invasive fashion extends beyond our work in the hospital. Our surgeons are active in research and education. We actively conduct research that examines the success of various operations/procedures and the impact that the procedure has had on our patients’ quality of life. Topics of active research include multi-institutional studies on the treatments of hyperparathyroidism, the impact of endocrine disorder on health care utilization and the value of standardization of care in patients with thyroid disease. Furthermore, we have assumed a local leadership role in the education and training of other medical colleagues. Our goal is to maintain an active role in the development of emerging treatments for endocrine diseases based on sound medical evidence.

Open/Current Studies

  • Parathyroid cancer:  Long term trends based on the National Cancer Database
  • Effect of parathyroidectomy on control of blood pressure in hypertensive patients with Primary Hyperparathyroidism
  • Health Care Utilization of Patients with Primary Hyperthyroidism in the primary care setting
  • Effect of standardization of thyroid ultrasound on cancer detection rate in a community hospital setting.

Recent Publications & Presentations

  • Compliance with NIH Guidelines in Management of Patients with Primary Hyperparathyroidism.  Presentation at the Pacific Coast Surgical Association.  Dana Pointe, CA, 2014.
  • Treatment Strategies for Primary Hyperparathyroidism: What is the Cost?  Presentation at the American Association of Endocrine Surgeons, 2012.  The American Surgeon.  In print 2013
  • Subxyphoid Thyroidectomy:  A Feasibility Study.  Surgical Innovations.  In print 2013.
  • Randomized Controlled Trial Comparing Single-Port Laparoscopic Cholecystectomy and Four-Port Laparoscopic Cholecystectomy.  Annals of Surgery.  April 2011.
  • Single Incision Laparoscopic Surgery.  9th Annual Postgraduate Minimally Invasive Course, Portland, OR, September 2011.
  • Updates on Parathyroid Surgery.  8th Annual Postgraduate Course in Minimally Invasive Treatment of Gastrointestinal Malignancies, Portland, OR, 2010.
  • Single Port Laparoscopic Surgery.  Nanjing Minimally Invasive Forum, Southeast University, Nanjing, China, November 2010.

Our care team is composed of physicians dedicated to the diagnosis and treatment of endocrine disorders. This means each doctor on your care team has specific interest and training in his or her area of expertise. These care providers then bring their specialties together to create a multidisciplinary patient-focused approach to the care of each patient.

A multidisciplinary team comprised of physicians specializing in various fields combine their skills to bring the most comprehensive, individualized and least invasive care to our patients.

Shaghayegh Aliabadi-Wahle, MD, FACS | Board Certified: General Surgery

M.D.: Tulane University School of Medicine, New Orleans, LA

Surgery Residency: Henry Ford Hospital, Detroit, MI

Organizations: American College of Surgeons, Endocrine Society

* Serves as Oregon Regional Medical Director of Surgery, Providence Health System

* Portland Monthly "Top Doctor" (2011, 2013, 2014, 2016)

Interests: Local & international surgical volunteerism & outreach projects

 

Richard Jamison, MD, FACS | Board Certified: General Surgery

M.D.: Mayo Medical School, Rochester, MN

Residency: Mayo Graduate School of Medicine, Rochester, MN

Honors & Awards: General Surgery Resident Teacher of the Year (Mayo Graduate School of Medicine)

Organizations: Western Surgical Association, American Society of General Surgeons.

 

Andru Bageac, MD

Diagnostic and Therapeutic Imaging

Radiology Specialist of the Northwest

Dr. Bageac received his medical degree from Harvard Medical School. He later completed his internship, research fellowship and diagnostic radiology residency at Beth Israel Deaconess Medical Center in Boston. Dr. Bageac also finished a nuclear radiology fellowship at the Harvard Medical School, Program. He is the Medical Director of Nuclear Medicine for Providence Portland Medical Center and a member of the American College of Radiology.

Michael Neuman, MD

Diagnostic Radiology

Radiology Specialist of the Northwest

Dr. Neuman attended the University of Wisconsin Medical School and completed a residency in Diagnostic Imaging at Michael Reese Hospital and Medical Center in Chicago. He has nearly 20 years of imaging experience in all facets of endocrine disease, including diagnosis of thyroid disorders and performance of over 1,000 thyroid biopsies. Dr. Neuman is the Medical Director for Diagnostic Imaging at Providence Portland Medical Center, Medical Director of the Safeway Foundation Breast Center, and a member of the Providence Portland credentials committee.

"I understand that patients are quite anxious when they come in for imaging procedures. It is my goal to make the experience as stress-free as possible." - Michael Neuman, MD

June Olson, MD

Pathology
Providence Health Systems

Dr. Olson graduated from the University of Colorado. She later completed her residency and became Chief Resident at the University of Utah, Department of Pathology. Dr. Olson finished a Surgical Pathology and Cytology fellowship at Case Western Reserve University in Ohio. She has served as the President of the Legacy Mount Hood Medical Staff and she is currently the Medical Director for Providence Hood River Laboratory. Dr. Olson is board certified in Anatomic and Clinical Pathology and has a subspecialty board certification in Cytology.