Endocrine Emergencies

Abstract

Endocrine surgery is commonly carried out in many hospitals, including thyroidectomy, parathyroidectomy, and adrenal surgery. Although we have selected specifically difficult endocrine management problems, it must be remembered that basic surgical management must be adhered to when dealing with the complications of endocrine surgery. For instance, after thyroid or parathyroid surgery, an increasing neck swelling will indicate an impending compartment syndrome due to perhaps hemorrhage. The consequence of this is potential airways compromise which can be easily treated by early removal of sutures and evacuation of hematoma, if necessary. Similarly, bilateral recurrent laryngeal nerve damage after surgery may result in bilateral vocal cord adduction and loss of airway in the perioperative phase which must be rapidly treated by either intubation or removal of sutures and tracheostomy. Furthermore, when dealing with potentially hormone-secreting tumors such as pheochromocytomas, care must be taken to exclude similar tumors in other locations. It is essential that multidisciplinary care is entered into early, and that when required, appropriate referral is made at the opportune time to more senior and/or specialist teams. The current national trend appears to be that much of the thyroid and parathyroid surgery is now carried out by ENT surgeons rather than general, endocrine, or other discipline head and neck surgeons. This is based upon the ability for thorough preoperative assessment (including voice measures and nerve function) and postoperative rehabilitation (speech and voice) and the treatment of possible complications that is now possible by otolaryngologists.