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Endocrine Surgery: Current Developments and Trends
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Endocrine Surgery: Current Developments and Trends

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (30 August 2025) | Viewed by 5498

Special Issue Editors

Dr. Leonardo Rossi

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Guest Editor
Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
Interests: general surgery; endocrine surgery; oncologic surgery; minimally invasive surgery; robotic surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Gabriele Materazzi

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Guest Editor
Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
Interests: thyroid; parathyroid; adrenal gland; oncologic surgery; endocrine surgery; minimally invasive surgery; robotic surgery; parathyroid fluorescence

Special Issue Information

Dear Colleagues,

The field of endocrine surgery is actracting growing interests and undergoing dynamic advancements, shaping the landscape of contemporary medical practices.

This Special Issue encompasses a spectrum of topics, including minimally invasive and remote-access procedures, novel oncologic management trends, innovative imaging technologies and cutting-edge diagnostic tools. Surgeons are increasingly embracing precision medicine, tailoring interventions to individual patient profiles for improved efficacy and reduced invasiveness. The integration of robotics and advanced endoscopic techniques led to endearing cosmetic outcomes and enhanced patient satisfaction. Moreover, the evolving landscape of endocrine surgery addresses the importance of multidisciplinary collaboration, incorporating insights from endocrinologists, radiologists and pathologists to ensure a comprehensive but tailored patient approach.

We welcome researchers with expertise in the field of endocrine health to contribute relevant articles to this Special Issue. We welcome original article, review and meta-analysis studies to spread the knowledge about current trends and developments, providing our readers with a perspective in the ever-evolving terrain of endocrine surgery.

Dr. Leonardo Rossi
Dr. Gabriele Materazzi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thyroid
  • parathyroid
  • adrenal gland
  • minimally invasive surgery
  • remote-access surgery
  • robotic surgery
  • parathyroid fluorescence
  • adrenal fluorescence

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Published Papers (6 papers)

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Research

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15 pages, 1985 KB  
Article
Multivisceral Resection for Suspected Adrenocortical Carcinoma
by Agata Dukaczewska, Peer I. Gottschalkson, Wenzel Schoening, Robert Oellinger, Knut Mai, Dominik Soll, Johann Pratschke, Frederike Butz and Martina T. Mogl
J. Clin. Med. 2025, 14(20), 7210; https://doi.org/10.3390/jcm14207210 - 13 Oct 2025
Abstract
Background: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Complete tumor resection (R0) is critical for prognosis and may require multivisceral resection in locally advanced cases. However, data on outcomes after multivisceral resection for ACC remain limited. This study evaluates the [...] Read more.
Background: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Complete tumor resection (R0) is critical for prognosis and may require multivisceral resection in locally advanced cases. However, data on outcomes after multivisceral resection for ACC remain limited. This study evaluates the perioperative and oncologic outcomes of patients undergoing multivisceral resection for suspected ACC. Methods: We retrospectively analyzed 21 patients who underwent multivisceral resection with curative intent for suspected ACC. Three were later diagnosed with other tumor entities (sarcoma, non-small cell lung carcinoma metastasis and ganglioneuroma). The remaining 18 patients with histologically confirmed ACC were compared with 19 patients who underwent isolated adrenalectomy during the same study period. Results: Patients undergoing multivisceral resection were significantly younger (p = 0.003), had larger (p < 0.001) and more advanced tumors according to ENSAT classification (p < 0.001). All but one had open surgery; laparoscopic or hybrid approaches were more common in the isolated adrenalectomy group. Multivisceral resections were associated with longer operative times (p = 0.002), all required an ICU admission (p < 0.001), and had longer hospital stays (p = 0.001). Lymphnode metastases were observed only in the multivisceral group (p = 0.002). No significant differences were found in complication rates (p = 0.081), resection status (p = 0.091), progression-free survival (p = 0.095), or overall survival (p = 0.71). Conclusions: Multivisceral resection is a safe and feasible approach in specialized centers and may achieve comparable oncologic outcomes to isolated adrenalectomy, even in patients with more advanced disease. It should be considered when R0 resection is required and technically achievable. Full article
(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)
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11 pages, 596 KB  
Article
Risk of Neck Hematoma Following Thyroidectomy in Patients Taking Direct Oral Anticoagulants: A Propensity Score Matching Analysis from Nine High-Volume European Centers (RAGNO Study)
by Gian Luigi Canu, Fabio Medas, Federico Cappellacci, Giulia Lanzolla, Leonardo Rossi, Francesco Pennestrì, Giacomo Di Filippo, Angeliki Chorti, Pierpaolo Gallucci, Andrea De Palma, Carlo Enrico Ambrosini, Ioannis Pliakos, Moysis Moysidis, Valentine Luzuy-Guarnero, Benoit Bédat, Giulia Salvi, Serena Elisa Tempera, Giulia Carnassale, Amelia Mattia, Giovanni Lazzari, Tommaso Guagni, Martina Izzo, Francesco Boi, Eleonora Morelli, Francesco Feroci, Emanuela Traini, Pietro Princi, Marco Stefano Demarchi, Theodosios Papavramidis, Marco Raffaelli, Gabriele Materazzi, Carmela De Crea, Pietro Giorgio Calò and RAGNO Study Collaborative Groupadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(10), 3435; https://doi.org/10.3390/jcm14103435 - 14 May 2025
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Abstract
Background: Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Methods: Patients who underwent thyroidectomy between January 2020 [...] Read more.
Background: Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Methods: Patients who underwent thyroidectomy between January 2020 and December 2022 in nine high-volume thyroid surgery centers in Europe were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided into two groups: the DOAC Group and the Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through a univariate analysis. Results: The total number of patients enrolled based on the inclusion/exclusion criteria was 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in the DOAC Group and 158 in the Control Group. In the DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of the incidence of this complication. Hospital readmission due to neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of the timing of the onset of neck hematomas that required surgical revision of hemostasis. Conclusions: This study showed that direct oral anticoagulants, in the field of thyroid surgery, have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs. Full article
(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)
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11 pages, 683 KB  
Article
Radiologist- and Surgeon-Performed Ultrasound (RSUS) Facilitates Minimally İnvasive Parathyroidectomy (MIP): Optimal Biochemical Parameters and Patient Outcomes
by Vahit Mutlu, Mahmut Arif Yuksek, Zafer Pekkolay, Zeynep Yegin, Ibrahim Halil Yildirim and Omer Uslukaya
J. Clin. Med. 2025, 14(7), 2279; https://doi.org/10.3390/jcm14072279 - 27 Mar 2025
Viewed by 685
Abstract
Background/Objectives: The high success rate of minimally invasive parathyroidectomy (MIP) is dependent upon the correct preoperative localization of the solitary parathyroid adenoma (SPA). Various studies have focused on comparisons of radiologist-performed ultrasound (RUS) and surgeon-performed ultrasound (SUS) to increase the sensitivity rate of [...] Read more.
Background/Objectives: The high success rate of minimally invasive parathyroidectomy (MIP) is dependent upon the correct preoperative localization of the solitary parathyroid adenoma (SPA). Various studies have focused on comparisons of radiologist-performed ultrasound (RUS) and surgeon-performed ultrasound (SUS) to increase the sensitivity rate of US. However, the efficiency of radiologist- and surgeon-performed ultrasound (RSUS) before MIP has not frequently been reported. We aimed to evaluate the efficiency of RSUS in clinical practice. Methods: In total, 122 patients (107 females, 15 males, mean age: 47.62 ± 15.75 years) with SPA were enrolled in our study design. The patients underwent preoperative ultrasonography (US) and technetium-99-sestamibi scintigraphy. Patient data including demographic characteristics, levels of biochemical parameters (parathyroid hormone (PTH), total serum calcium and phosphorus levels), operation time, and length of hospital stay were recorded. Results: MIP was performed with success under local anesthesia following the accurate localization of the adenomas by RSUS. The mean operation time was 20.00 ± 3.87 min. The mean preoperative serum PTH, calcium, and phosphorus levels were 525.69 ± 1050.92 pg/mL, 11.38 ± 1.22 mg/dL, and 2.53 ± 0.60 mg/dL, respectively. The decline in the perioperative PTH and calcium levels reflecting a cure was observed on the first postoperative day. Postoperative sixth month evaluations of the PTH and calcium levels confirmed the significant decrease, reflecting the therapeutic cure. Since no complications occurred, the hospital discharge process was carried out on the same day. Conclusions: RSUS is a beneficial adjunctive tool to facilitate MIP, and it achieved satisfactory therapeutic success in all the patients. Full article
(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)
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Review

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29 pages, 2125 KB  
Review
Hungry Bone Syndrome After Parathyroidectomy for Secondary Hyperparathyroidism: Pathogenesis and Contemporary Clinical Considerations
by Adina Coman, Cristi Tarta, Marco Marian, Daian Ionel Popa, Sorin Olariu, Mihai Rosu, Diana Utu, Florina Buleu, Anca-Monica Macovei-Oprescu, Dorin Novacescu, Flavia Zara and Marius Murariu
J. Clin. Med. 2025, 14(19), 7104; https://doi.org/10.3390/jcm14197104 - 9 Oct 2025
Viewed by 361
Abstract
Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone [...] Read more.
Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL/OPG dysregulation, Wnt/β-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery. Full article
(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)
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30 pages, 558 KB  
Review
An Analysis of Post-Adrenalectomy Dynamics in MACS (Mild Autonomous Cortisol Secretion)-Positive Adrenal Tumours: The Biomarkers and Clinical Impact
by Alexandra-Ioana Trandafir, Mara Carsote and Alexandru-Florin Florescu
J. Clin. Med. 2025, 14(15), 5217; https://doi.org/10.3390/jcm14155217 - 23 Jul 2025
Viewed by 1078
Abstract
Background/Objective: One third of “non-functioning adrenal tumours” (NFAs) have mild autonomous cortisol secretion (MACS). An updated analysis of the hormonal biomarkers profile, including risk factors and the rate of post-surgery adrenal insufficiency (PSAI), the duration of restoring the normal adrenocortical function in MACS/NFA [...] Read more.
Background/Objective: One third of “non-functioning adrenal tumours” (NFAs) have mild autonomous cortisol secretion (MACS). An updated analysis of the hormonal biomarkers profile, including risk factors and the rate of post-surgery adrenal insufficiency (PSAI), the duration of restoring the normal adrenocortical function in MACS/NFA and potential impacts on clinical comorbidities. Methods: Comprehensive review based on PubMed search (January 2020–January 2025). Results: The studies (n = 14) included 2623 patients (N = 1158 underwent unilateral adrenalectomy), aged 18–93 (mean = 57.49 years), with a female-to-male ratio = 1.54. Post-adrenalectomy (n = 9, N = 753) analysis: the PSAI risk correlated with the severity of baseline hypercortisolism. PSAI incidence: 50% of MAC. The rate after 4–6 weeks follow-up was 71.9% (adrenal Cushing’s syndrome) vs. 50% (MACS) vs. 14.4% (NFA). PSAI duration was up to 35 months. Early PSAI diagnosis was reflected by post-operative cortisol assay on day 1 (cut-off ≤ 5 µg/dL) and an ACTH (Cosyntropin) stimulation test (CST) (cortisol cut-off ≤ 14 µg/dL). Pre-operatory PSAI predictors: higher serum cortisol-DST (1 mg dexamethasone testing) and lower baseline plasma ACTH (not all studies agreed). Conclusions: A stratified strategy is encouraged following a unilateral adrenalectomy in MACS; PSAI is expected in almost half of patients, with a potential improvement of hypertension. Serum cortisol assays serve as most useful biomarker as pre-operatory PSAI predictor (after DST) and, potentially, in addition with baseline ACTH. Post-surgery basal cortisol measurement (± CST) helps the decision of glucocorticoids replacement since first post-operative day and during follow-up, serial testing at 3 months is a useful tool. Full article
(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)
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Other

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8 pages, 2513 KB  
Brief Report
Value of Neuroradiology Second Reads of CT Scans for Hyperparathyroidism
by Javier Bravo Quintana, Michael Bouvet, Jennifer Chang and Julie Bykowski
J. Clin. Med. 2025, 14(9), 2865; https://doi.org/10.3390/jcm14092865 - 22 Apr 2025
Viewed by 630
Abstract
Background/Objectives: Parathyroidectomy is a curative procedure for primary hyperparathyroidism, and multi-phase CT is an integral part of surgical planning. While patients may be referred to centers specializing in endocrine surgery, their imaging may be performed at other facilities without the same high-volume [...] Read more.
Background/Objectives: Parathyroidectomy is a curative procedure for primary hyperparathyroidism, and multi-phase CT is an integral part of surgical planning. While patients may be referred to centers specializing in endocrine surgery, their imaging may be performed at other facilities without the same high-volume expertise. Methods: A retrospective review was performed of radiologist second reads of outside neck CT imaging in patients with hyperparathyroidism referred for surgical management. Results: The initial outside report was 59% sensitive for localization of parathyroid adenoma in the 74 patients with surgical pathologic confirmation. Second reads of the same CT scans correctly identified the parathyroid adenoma in an additional 24% of patients, for a total sensitivity of 83%. For the 23% of patients with pathologically confirmed multi-gland involvement, the initial outside report was 21% sensitive for lesion detection, and the second read of the same scans was 68% sensitive. Conclusions: Endocrine surgeons should be aware that community-based radiology interpretation of neck CT may be less sensitive than reported series from academic and high-volume practices. In the present study, interpretation via second read of outside CT scans by a neuroradiologist engaged with the endocrine surgery service line increased the sensitivity of detecting candidate lesions, both for single-gland and multi-gland involvement. While it is preferred to have preoperative imaging and interpretation within the same high-volume center as the surgeon for consistency of imaging quality, experience and communication, radiologist second reads deserve financial and service line support when that is not possible given the impact on surgical planning and patient care. Full article
(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)
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