Daniel J. Ledbetter, MD, FACS, FAAP

Professor of Surgery

University of Washington

Attending Surgeon

Seattle Children's Hospital

Seattle, Washington, USA



Paul R. V. Johnson, MBChB, MD, FRCS(Eng), FRCS (Edin), FRCS (Paed.Surg), FAAP



Professor of Pediatric Surgery

University of Oxford

Director of the Oxford Islet Transplant Programme

Academic Pediatric Surgery Unit

Nuffield Department of Surgical Sciences

John Radcliffe Hospital

Oxford, UK 

Endocrine Surgery in Children     Daniel J. Ledbetter, MD, FACS, FAAP Professor of Surgery University of Washington Attending Surgeon Seattle Children's Hospital Seattle, Washington, USA   Paul R. V. Johnson, MBChB, MD, FRCS(Eng), FRCS (Edin), FRCS (Paed.Surg), FAAP Professor of Pediatric Surgery University of Oxford Director of the Oxford Islet Transplant Programme Academic Pediatric Surgery Unit Nuffield Department of Surgical Sciences John Radcliffe Hospital Oxford, UK       Foreword   Endocrine conditions requiring surgery in children are extremely rare. Surgeons undertaking this surgery need to be specifically trained and exposed to a large volume of cases in order to maintain their expertise. Therefore it is clear that the surgery needs to be concentrated in designated regional centres and carried out by a select number of paediatric surgeons. In addition, a close working relationship with the paediatric endocrinologists is essential for the overall wellbeing of the child. While management of many of these conditions must remain within the armamentarium of the paediatric surgeon, for example neuroblastoma, hyperinsulinism, adrenal tumours and gonadal conditions, there is a tendency to engage adult endocrine surgeons with specific expertise in a particular organ, such as thyroid, parathyroid, pituitary, to perform the procedures in conjunction with the paediatric surgeons. In the latter situation, it is important that the overall care of the child should remain firmly in the province of the paediatric specialist. This book devoted to the surgery of endocrine disorders in children fills a major gap in the paediatric surgical literature and brings together the full range of endocrine conditions encountered in the paediatric age range. The last publication devote to the surgery of endocrine disorders in children was part of the Progress in Pediatric Surgery series (now discontinued) published in 1991. This publication includes contributions from international authorities in paediatric surgery and endocrinology, mainly from the United Kingdom and North America and should be viewed as the standard text for many years to come.   Lewis Spitz MD, PhD, FRCS(Edin, Eng, I), FRCHCP, FAAP, FCS(SA), FACS Emeritus Nuffield Professor of Paediatric Surgery Institute of Child Health, University College, London Hon. Consultant Paediatric Surgeon Great Ormond Street Hospital NHS Trust London, UK     Preface   Endocrine surgical conditions during childhood are relatively rare. However, they represent an interesting and challenging group of conditions that all Pediatric Surgeons will encounter sometime during their careers. This book is one of the first to provide a specific overview of the range of different endocrine surgical conditions encountered in children, together with their management.  It is aimed at any surgeon operating on endocrine conditions in children and adolescents.  . The book is divided into sections based on the different endocrine organs. Each section begins with a chapter outlining the embryology, anatomy, and physiology of that organ, before subsequent chapters address the different surgical conditions that occur, together with their diagnosis, management, and outcomes. Basic science and 'state of the art' research perspectives are included as they relate to surgical decision-making and optimal clinical care. We have intentionally chosen a diverse group of authors who have experience and expertise in caring for children with endocrine surgical conditions in North America and in the UK. The authors include endocrinologists, adult endocrine surgeons, and paediatric surgeons, and represent many who are at the forefront of both clinical care and cutting edge research. One of the key messages that comes out throughout the book is that rare endocrine surgical conditions require a collaborative multi-disciplinary team approach to ensure that the children receive the very best management resulting in the most favourable outcomes.   It is our hope that this international, multidisciplinary perspective will give surgeons caring for children with endocrine conditions requiring surgery, additional insights that will lead to a better understanding of the conditions and ultimately improved patient care.   Dan Ledbetter and Paul Johnson         Dedication   To Sunny, Kelly, and Brian - the greatest joys of my life. DJL   To Hilary, Thomas, and Tilly - for your unconditional love, support, and patience during the preparation of this book. PRVJ     Acknowledgments   We want to thank the many people who have directly and indirectly contributed to this book. First, we would like to thank our mentors who stimulated our interests in pediatric endocrine surgery. These include the late David Tapper and the late Nick Dudley, both of whom demonstrated excellence in the operative care of children. Next, Diana Farmer, who persuaded the American College of Surgeons that a panel discussion of endocrine problems in children deserved a place on the program of its annual Clinical Congress. That panel discussion was the primary inspiration for this book.    Next, we would like to thank Springer, who supported this book through its long gestation to publication. In particular we would like to thank Margaret Burns who guided the book throughout its development to the point of completion. We would also like to thank all the contributing authors. They have shown remarkable patience throughout the production of the book and without them this book would clearly not have been possible.   We would like to thank all our excellent clinical colleagues in Anesthesia, Surgery, Pathology, Radiology, Endocrinology, and Oncology at both Seattle Children's Hospital and the Children's Hospital in Oxford who have helped care for the many and varied patients with endocrine problems who have needed surgery. This includes pediatric surgical colleagues in the Division of Pediatric General and Thoracic Surgery in Seattle (Robert Sawin, John Waldhausen, Pat Healey, Adam Goldin, Ken Gow, John Meehan, George Drugas, Jeff Avansino, Patrick Javid, and Kim Riehle) and in the Department of Paediatric Surgery , Endocrinology, and Endocrine Surgery in Oxford (Hugh Grant, Kokila Lakhoo, Silke Wagener, Alex Lee, Ian Willetts, Rosa Romero, Radu Mihai, Fiona Ryan, and Taffy Makayer). Finally, we would like to thank all the surgical trainees including residents, fellows, core trainees, and registrars who do much of the work in the hospital, but more importantly, ask many of the most important questions that inspire everyone to discover new and better ways to care for children.       Foreword Preface Dedication Acknowledgments Contributors I. Thyroid 1. Thyroid Gland Embryology, Anatomy, and Physiology Gerard Walls and Radu Mihai 2. Hyperthyroidism Betty Panayota Messazos, Radu Mihai, and Fiona Jane Ryan 3. Thyroid Nodules in Children Geoffrey K. Blair and Daniel J. Ledbetter 4. Thyroid Cancer in Children Daniel J. Ledbetter II. Parathyroid 5. Parathyroid Gland Embryology, Anatomy, and Physiology Gerard Walls and Radu Mihai 6. Parathyroid Surgery in Children Jocelyn Burke, Herbert Chen, and Ankush Gosain III. Adrenal 7. Adrenal Gland Embryology, Anatomy, and Physiology Sanjeev Vasudevan and Mary L. Brandt 8. Phaeochromocytoma Michael J. Stechman and Gregory P. Sadler 9. Neuroblastoma Keith Holmes 10. The Evaluation and Management of Adrenal Masses and Adrenocortical Tumors Kenneth W. Gow IV. Pancreas 11. Pancreas Embryology, Anatomy, and Physiology Yousef El-Gohary and George K. Gittes 12. Congenital Hyperinsulinism Khalid Hussain, Shireen A. Nah, and Agostino Pierro 13. Pancreatic Neuroendocrine Tumors Paul R. V. Johnson 14. Islet Cell Transplantation Antonio Bruni, Michael McCall, and A. M. James Shapiro 15. Diabetes in the Pediatric Surgical Patient Ari J. Wassner and Michael S. D. Agus V. Bariatric Surgery 16. Assessing and Selecting Patients for Bariatric Surgery Thomas H. Inge 17. Bariatric Surgery in Children Mansoor Ali Khan and Roger Ackroyd VI. Ovary, Testicles, and Fertility 18. Pathogenesis and Treatment of Disorders of Sexual Development Rafael V. Pieretti 19. Testis Embryology, Anatomy, and Physiology John Hutson 20. Surgical Considerations of Testicular Maldescent John Hutson 21. Testicular Torsion Daniel W. Colliver and David F. M. Thomas 22. Testicular Tumors in Children Yaser El-Hout and Darius J. Bägli 23. Ovarian Embryology, Anatomy, and Physiology Including Normal Menstrual Physiology         Contributors   Roger Ackroyd, MBChB, MD(Distinction), FRCS(Eng), FRCS(Ed), FRCS(Gen Surg) Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK   Michael S. D. Agus, MD Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA  USA   Darius J. Bägli, MDCM, FRCSC, FAAP, FACS Department of Surgery, Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada   Geoffrey K. Blair, MD, FRCSC Division of Pediatric Surgery, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada   Mary L. Brandt, MD Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA   Samuel R. Browd, MD, PhD, Facs, Faans, Faap Department of Neurological Surgery, University of Washington, Seattle, WA, USA   Antonio Bruni, BSc Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, Canada   Jocelyn Burke, MD Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA   Herbert Chen, MD Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA   Daniel W. Colliver, FRCS Department of Paediatric Surgery and Urology, Queens Medical Centre, Nottingham, UK   Mehul T. Dattani, MBBS, MD, FRCPCH, FRCP Developmental Endocrinology Research Group, Clinical and Molecular Genetics Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK   Jennifer E. Dietrich, MD, MSc Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, TX, USA   Yousef El-Gohary, MD, MRCS (Glasg) Department of Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA   Yaser El-Hout, MD Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon   Anne C. Fischer, MD, PhD Department of Pediatric Surgery, Tenet Florida Physician Services, West Palm Beach, FL, USA    George K. Gittes, MD Department of Pediatric Surgery and Surgery, Children's Hospital of Pittsburgh; Division of Pediatric Surgery, University of Pittsburgh, School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA   Tim Goodacre, FRCS, BSc, MB, BS  Nuffield Department of Surgery, University of Oxford, Oxford, UK   Ankush Gosain, MD, PhD Department of Surgery, Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA   Kenneth W. Gow, MD Department of General and Thoracic Surgery, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA   Keith Holmes, ChM, FRCS, DCH Department of Paediatric Surgery, St. George's Hosptial, London, UK     Khalid Hussain, MBChB, MRCP, MSc Developmental Endocrinology Research Group, Clinical and Molecular Genetics Unit, Institute of Child Health/Great Ormond Street Hospital for Children, University College London, London, UK   John Hutson, MD Department of Paediatrics, University of Melbourne; Department of Urology, Royal Children's Hospital, Melbourne; Douglas Stephens Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne Royal Children's Hospital, Parkville, Victoria, Australia