An Endocrine Surgeon's Daily Schedule

An endocrine surgeon is a surgical sub-specialist who trains in the diagnosis and surgical management of conditions and illnesses that affect the endocrine organs. These are organs that secrete hormones into the bloodstream of the body and regulate certain bodily activities and functions such as metabolism, sensory perception, growth and development, tissue function, digestion, respiration, sleep, mood, stress, reproduction, lactation, excretion and movement.

The endocrine glands that are operated on by these surgeons include the thyroid gland, parathyroid glands, pancreas and adrenal glands. Endocrine diseases and disorders that need medical treatment are managed by specialist physicians known as endocrinologists, and they refer patients to endocrine surgeons where medical therapy is not successful and they therefore need further surgical intervention.

Training

In order to qualify as an endocrine surgeon, a doctor must complete certain mandatory training programmes and degrees. These include completing a 5-6 year surgical and medical undergraduate degree where the medical student qualifies as a medical doctor. This is then followed by exposure to various medical and surgical disciplines when performing a 1-2 year internship phase.

The qualified doctor is then allowed to specialise further, and they will enter and complete a 5 year general surgery residency where they will qualify as a general surgeon. The surgeon will then have to complete a 2 year fellowship in endocrine surgery in order to become such a surgeon.

Conditions managed and procedures performed by Endocrine Surgeons

The following section will discuss the endocrine pathologies encountered by an endocrine surgeon and the procedure(s) they will perform on these patients.

Thyroid gland

Surgery on the thyroid gland entails removing most of this organ's tissue when patients are diagnosed with conditions such as a multi-nodular goitre and thyroid cancer.

The types of procedures performed by these specialists on the thyroid gland include complete removal of the organ (total thyroidectomy), partial removal of the gland (hemi-thyroidectomy or thyroid lobectomy) and incomplete resections of the thyroid (near-total or sub-total thyroidectomy). The latter though aren't performed as commonly as the other and have fallen out of favour with the endocrine surgeons.

Pancreas

Rarely do conditions involving the pancreas occur that they need surgical intervention, but there are cases that do need this therapy and they include gastrinomas and insulinomas. The surgical procedures performed on the pancreas can range from large resections of the organ to simple tumour enucleation.

READ The Daily Schedule Of An Endocrinologist

Parathyroid glands

The human body has four small parathyroid hormones that are located behind each corner of the thyroid gland. The removal of one or many of these glands is called a parathyroidectomy and will be performed in patients diagnosed with primary hyperparathyroidism. 

Primary hyperparathyroidism is usually caused by a parathyroid adenoma, where one of these glands converts into a benign tumour that enlarged and then causes parathyroid hyperactivity. In this case, only the pathological mass will be removed.

Adrenal glands

Conditions such as a pheochromocytoma, Conn syndrome and adreno-cortical cancer warrant the removal of an affected adrenal gland, and the procedure is called an adrenalectomy.

The Daily Schedule Of An Endocrine Surgeon

Endocrine surgeons consult with their post-operative patients on a daily schedule, and they will manage these patients until they are ready to be discharged home. An important aspect to monitor is to make sure that the patient's hormonal levels, regarding the endocrine gland that was operated on, are at normal and clinically appropriate levels before they are discharged.

Endocrine surgeons will have their offices located in the hospital as this offers faster access to their hospital patients and to consult with casualty department patients when needed. This specialist will provide on call services to the hospital they work at during after hours and weekend periods where they will be consulted by nursing staff, casualty doctors and primary healthcare workers.

Emergency cases that need to be managed by endocrine surgeons include surgically managing the causes of a patient's signs and symptoms. These are hypoglycaemia due to insulinomas, thyroid storm due to an overactive enlarged thyroid, catecholamine crisis caused by a pheochromocytoma on the adrenal glands and tetany caused by hyperparathyroidism.

Monday

Monday mornings are usually used to attend meetings with surgical representatives and hospital management and staff, but also to sort out the clinical and non-clinical administrative tasks of the office.

The endocrine surgeon will then start consulting with patients once all these aspects have been sorted. The patients that are seen during the day include first time patients referred by primary healthcare workers and endocrinologists and follow up patients who were previously operated on.

The specialist will consult these patients and send them for any necessary investigative procedures, such as blood tests, ultrasounds, CT scans and any nuclear studies on affected glands, and will either admit them to the ward for further investigations and management or schedule them for surgery on an elective date.

Tuesday

The endocrine surgeon will spend the entire Tuesday operating in theatre. Usually the more complex and time consuming procedures are performed in the morning and the less complex procedures are reserved for the afternoon.

The surgeon may decide to focus on the thyroid and adrenal glands on this day and reserve procedures on the other glands for another day in the week.

Wednesday

The endocrine surgeon will spend the morning in theatre and may decide to focus on operating on pathologies involving the pancreas.

The afternoon will be used to consult further with patients or perform other administrative tasks such as filling in motivation letters to medical aid companies, regarding authorization for surgeries, or performing research for their own academic purposes.

READ What is a reproductive endocrinologist?

Thursday

The specialist will perform surgery during the morning and will then focus on the surgical intervention of conditions affecting the parathyroid gland.

The afternoon will be used to train postgraduate general surgeon and endocrine fellows, as well as undergraduate medical students.

Friday

The endocrine surgeon will consult with and manage patients for the morning session, and deal with any unresolved administrative issues that need their attention in the early afternoon.

The work week can then conclude once all these duties have been completed and the surgeon has confirmed their surgical list for the following week.