Surgery of the endocrine glands in pregnancy.

The surgical endocrinology of the pregnant patient is special with respect to the additional hazards of maternal and fetal loss under the stress of pregnancy, labor, and delivery. The added threat of drug, radiation, radioisotope, anesthetic, and surgical management requires extra precaution in diagnostic and therapeutic manipulation, and limitations are imposed by appropriate reluctance to employ radioisotopes or external radiation in localizing or treating focal endocrine tumors. The state of pregnancy itself causes some endocrine hyperfunction that is normal, and the normal types must be distinguished from those that are pathologic, with consideration of the hormone values that would be pathologic in the nonpregnant state. The physician must be concerned with hyperfunctioning and hypofunctioning endocrine systems in their effect on the mother and their frequently reciprocal effects on the fetus in the maternal/fetal unit. The most directly life-threatening concerns of endocrine surgery in the pregnant patient are those of thyrotoxicosis, hyperparathyroidism, insulinoma, and, most particularly, pheochromocytoma. The severe consequences of unsuspected pheochromocytoma in the pregnant patient are evident in maternal and fetal mortality that approximates nearly 50%. The only reduction in the lethal consequences in the combination of pheochromocytoma and pregnancy can be made through continual suspicion and early diagnostic efforts with patients who manifest cardiovascular, neurologic, blood sugar, or blood pressure abnormalities in pregnancy. Some of the endocrine syndromes may not only affect and be affected by pregnancy but may be passed on through it to kindred in familial syndromes. The multiple endocrine adenopathies that are known are genetically expressed as autosomal dominant traits. Careful screening methods for case-finding among affected families is important follow-up to genetic counseling.