Sharp as a knife

Endocrine Surgeryedited by John R. Farndon. Saunders, 2001. US$75.00 (xiv + 319 pages) ISBN 0 7020 2594As an endocrinologist who collaborates extensively with endocrine surgeons, I was very interested to review Endocrine Surgery edited by John R. Farndon. The aim of this short text is the concise delivery of specialized information for surgeons in training as well as the practicing surgeon who needs relevant information at his or her fingertips. The authors have succeeded in producing a surgical textbook that carefully presents up-to-date diagnostic evaluations and medical management with few weak areas.The organization of the book is generally thoughtful. In contrast to the first edition, the surgical management of disease of the mammary gland is appropriately excluded. However, the inclusion of salivary gland surgery is illogical and would have been better suited for a companion to otolaryngology; not all'glands' are of interest to the endocrine surgeon. The discussions of glands that are of great interest to endocrine surgeons, notably the parathyroids, thyroid, adrenals and pancreas are concise, and contain a wealth of practical information. Hereditary tumor syndromes and carcinoids are addressed in separate chapters. A few chapters summarize important studies that contribute to evidence-based surgical practice and are marked in the text by a scalpel icon in the margin. Comprehensive reviews and landmark studies that have directed medical practice are also marked by the scalpel icon in the reference section of each chapter. The editors unapologetically point out the apparent dearth of studies to guide the clinical practice of surgery. Regardless of this paucity of information, the editors should be commended for making the effort.The parathyroid chapter includes sections on the differential diagnosis, genetic defects and clinical manifestations of hyperparathyroidism. The medical treatment of primary hyperparathyroidism, including clinical trials of the calcium-sensing receptor agonist, is presented in depth. Curiously, new and important topics in parathyroid surgery, such as minimally invasive surgery and the use of intraoperative parathyroid hormone measurements, are simply mentioned, in contrast to the extensive discussion of medical therapy or the discussion of the clinically irrelevant topic, dynamic testing of parathyroid function.Disorders of the thyroid are reviewed broadly and leave few areas uncovered. One notable omission is preparation of the thyrotoxic patient for surgery. Likewise, the adrenal chapter fails to provide a risk assessment in the hypercortisolemic patient addressing issues of coagulation, immune deficiency and wound healing.The chapter on familial endocrine diseases covers the well-known syndromes such as multiple endocrine neoplasia (MEN-1 and MEN-2), but also briefly mentions Carney Complex, familial isolated hyperparathyroidism and jaw tumor-hyperparathyroidism. The inclusion of newer features of the MEN-1 syndrome, such as angiofibromas and collagenomas, will be appreciated by those who have an interest in this field. The surgical management of parathyroid and pancreatic endocrine tumors (PET) in this chapter is not fully developed. Luckily, PET management in MEN-1 is discussed more fully in the chapter dedicated to endocrine tumors of the pancreas.The weakest chapter in Endocrine Surgery is dedicated to issues of clinical governance and the quality in endocrine surgery. Clinical controversies are presented as bulleted lists, such as the use of radioiodine versus surgery in the treatment of retrosternal goiter, or the size of an adrenal incidentaloma that should be surgically removed. These interesting questions compel the reader to go back to the organ-specific chapters only to discover that the controversial questions raised are not addressed.In summary, Endocrine Surgery is a solid text that broadly reviews the issues with which surgical trainees must gain expertise. As a medical endocrinology fellowship training director, I would also recommend this text to our trainees to refine their understanding of the multidisciplinary understanding required to deliver comprehensive patient care.