Indian Journal of Endocrine Surgery and Research

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2022 | July-December | Volume 17 | Issue 2

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Message from the Desk of Editor-in-Chief

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijesr-17-2-iv  |  Open Access |  How to cite  | 


Surgeons and Creativity

Vargees Thomas

Surgeons and Creativity

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijesr-17-2-v  |  Open Access |  How to cite  | 


Review Paper

Analyzing Nipple Discharge: A Surgeon's Perspective

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:8] [Pages No:53 - 60]

Keywords: Benign breast disease, Breast lump, Diagnostic evaluation, Duct ectasia, Nipple discharge, Prolactinoma

   DOI: 10.5005/jp-journals-10088-11199  |  Open Access |  How to cite  | 


Aim: This review article aims to provide a bird's-eye view for a surgeon dealing with a patient with Nipple discharge (ND). Background: Nipple discharge is the third most common complaint of a woman visiting a breast clinic. It can be physiological, due to benign disorders like duct ectasia or can be a presenting symptom of breast cancer. Hence, it is extremely important to evaluate every patient with ND thoroughly with robust history and clinical examination followed by necessary investigations like ultrasonography and mammography (MMG). Review results: Ultrasonography and MMG are the mainstays in the evaluation of ND. The role of magnetic resonance imaging, ductography, ductoscopy, and nipple aspiration cytology is not very well-defined and is evolving. Nonbreast etiologies of ND also need to be considered and relevant investigations to manage such patients are needed, clues for which lie in the presenting complaints of the patients. Various drugs also interfere with the physiology of breast secretions and are an important cause of ND and need to be managed appropriately. Management of ND should be directed toward the inciting cause of the disease. Surgical options include microdochectomy or a more radical Hadfield's surgery. Conclusion: Directed investigations to determine the etiology of ND guided by clues found during the clinical examination of a patient can help in the appropriate treatment of ND and also avoid unnecessary surgery. Clinical significance: Nipple discharge is one of the most common complaints with which a woman attends a breast clinic and needs to be approached systematically to identify the cause and decide on appropriate management strategies.


Review Paper

Shiva Madan, Neha Nagpal, Hans Raj Pahadiya

Gynecomastia: Clinical Review and Endocrinology Perspectives

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:3] [Pages No:61 - 63]

Keywords: Gynecomastia, Klinefelter syndrome, Lipomastia, Mammoplasty, Tamoxifen

   DOI: 10.5005/jp-journals-10088-11202  |  Open Access |  How to cite  | 


Gynecomastia is the term used to describe the benign growth of glandular breast tissue in men. The most common causes are pubertal gynecomastia, hypogonadism, and drugs. An imbalance in the actions of free estrogen and androgens in the breast tissue is the root cause of gynecomastia. Physiologic or pubertal gynecomastia is a common finding in mid-puberty, with pubic hair present in Tanner stage III–IV. Gynecomastia is commonly bilateral, however, 20% of pubertal boys have unilateral disease. In gynecomastia, evaluation needs history – onset, progression, associated pain, medication history, and symptoms of hypogonadism. True gynecomastia and pseudogynecomastia should be distinguished by the feel of glandular or fat tissue. The testis and abdomen examination is an essential part of the examination. It is reasonable to measure the levels of serum testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), prolactin, thyroid stimulating hormone (TSH), serum estradiol, serum human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), liver function test, and renal function test in peripubertal boys with macromastia (Tanner stage III or greater) and adult males with newly developing gynecomastia, fast growth, and eccentric or hard, irregular masses or gynecomastia larger than 4 cm inch. Physiologic gynecomastia usually resolves on its own. In 75–90% of adolescents, pubertal gynecomastia resolves independently after 1–2 years. Aromatase inhibitors, e.g., letrozole and estrogen receptor modulators, e.g., tamoxifen (10–20 mg daily), are recommended for painful pubertal gynecomastia or macromastia (Tanner staging III or more). If the gynecomastia is persevering (>2 years) and very disturbing to the boy, surgical reduction, mammoplasty by an experienced surgeon can be pursued.



Diagnostic Obscurity in a Case of Large Right Suprarenal Mass

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:3] [Pages No:64 - 66]

Keywords: Chromophobe variant of renal cell carcinoma, MIBG scan, Pheochromocytoma

   DOI: 10.5005/jp-journals-10088-11194  |  Open Access |  How to cite  | 


Aim: Aim of this case report is to highlight the difficulties we faced in differentiating renal mass from the adrenal mass. Background: MIBG positive uptake usually signify a neuroendocrine tumor. However, there is reported false positive MIBG uptake in the chromophobe variant of renal cell carcinoma (RCC). Case description: A postmenopausal lady in her early 70s presented to our outpatient clinic with right-sided flank pain radiating to the back. On examination, a right hypochondriac region lump of size 10 × 8 cm was found. Contrast-enhanced computed tomography (CECT) scan done elsewhere showed a large, well-defined, smooth, lobulated, heterogeneously enhancing soft tissue lesion involving the upper pole of the right kidney measuring 15.5 × 11.4 × 11.2 cm, suspected to be an adrenal mass. The hormonal evaluation was inconclusive and the iodine-123-meta-iodobenzylguanidine (MIBG) scan showed concentration in the right suprarenal region. In view of the inconclusiveness of the findings, a repeat dedicated adrenal protocol CECT scan was done, which showed a mass arising from the superior pole of the kidney. The patient underwent open radical nephrectomy and final histopathology showed a chromophobe variant of RCC, which had shown a false positive uptake in the MIBG scan. Conclusion: We must interpret radiological, clinical and pathological aspects of large suprarenal mass during evaluation and be aware of false positive uptakes in MIBG scan. Clinical significance: An MIBG scan is a good tool for assessing the functionality of the neuroendocrine lesion, but we should always keep in mind the other conditions that can take up MIBG.



Sinjan Jana, Ranu Tiwari Mishra, Noopur Gupta, Ria Yadav

Extramedullary Hematopoiesis in a Giant Adrenal Myelolipoma: A Case Report

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:67 - 68]

Keywords: Adrenal myelolipoma, Case report, Extramedullary hematopoiesis, Hemolytic anemia

   DOI: 10.5005/jp-journals-10088-11198  |  Open Access |  How to cite  | 


Introduction: Adrenal myelolipoma with extramedullary hematopoiesis (EMH) is an exceedingly rare entity with very few cases reported in the literature. We present a rare case of adrenal myelolipoma with EMH. Case report: A 48-year-old man with the previous history of splenectomy for hereditary spherocytosis was presented with 12 × 12 cm right adrenal tumor and underwent laparoscopic adrenalectomy. The histopathological features confirmed the diagnosis of adrenal myelolipoma with EMH. Conclusion: In any patient with a history of chronic hemolytic anemia and adrenal mass, it is imperative to consider EMH as a possible diagnosis.



Ashwinee Rahalkar

Unusual Presentation of Thyroid Storm in a Patient with Metastatic Follicular Carcinoma of Thyroid

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:3] [Pages No:69 - 71]

Keywords: Diabetes mellitus, Metastatic follicular thyroid carcinoma, Thyroidectomy, Thyroid storm

   DOI: 10.5005/jp-journals-10088-11201  |  Open Access |  How to cite  | 


Thyroid storm (TS) is a rare, acute life-threatening complication with a high mortality rate. We present a case report of the unusual presentation of TS in a patient with metastatic follicular thyroid carcinoma with poorly controlled diabetes mellitus.



Compal Chauhan, Nitisha Sharma, Manisha Kumari

Queries regarding “Anaplastic Thyroid Carcinoma: Spot Diagnosis”

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:1] [Pages No:72 - 72]

Keywords: Anaplastic thyroid carcinoma, Endocrine cancer, Pemberton maneuver

   DOI: 10.5005/jp-journals-10088-11193  |  Open Access |  How to cite  | 


Anaplastic thyroid cancer (ATC) is one of the most aggressive solid organ cancers with high mortality. Even after so much progress in chemotherapy, radiotherapy, and surgical techniques, we lose almost all patients within 2 years of diagnosis. The very low threshold for suspecting ATC and Prompt diagnosis are crucial factors in the management of ATC.



Ankur Jain

Trapped: Right-sided Nonrecurrent Laryngeal Nerve without Any Vascular Aberration

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:73 - 74]

Keywords: Endocrine, Thyroid, Thyroid surgery

   DOI: 10.5005/jp-journals-10088-11195  |  Open Access |  How to cite  | 



Sarah Idrees

Tattooing for Thyroid Disorders: Will it Help it the Knife Happy Endocrine Surgeons?

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:75 - 76]

Keywords: Endocrine surgery, Euthyroid, Thyroid

   DOI: 10.5005/jp-journals-10088-11196  |  Open Access |  How to cite  | 


Journal Watch

Sarrah Idrees

“Thyroidectomy in Australia 2022: Lessons from 21,000 Consecutive Cases”. Published in ANZ Journal of Surgery

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:1] [Pages No:77 - 77]

Keywords: Thyroid, Thyroid surgery, Thyroidectomy

   DOI: 10.5005/jp-journals-10088-11197  |  Open Access |  How to cite  | 


Photo Assay

Sarrah Idrees, Ankur Mandelia

Organic Hypercortisolism of Childhood: Adrenal Cushing's Syndrome

[Year:2022] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:78 - 79]

Keywords: Adrenal adenoma, Hypercortisolism of childhood, Pediatric Cushing's syndrome

   DOI: 10.5005/jp-journals-10088-11200  |  Open Access |  How to cite  | 


Adrenocortical tumors (ACTs) only account for 0.3–0.4% of all neoplasms in childhood. In this article, we have discussed the clinical features, evaluation, and treatment of adrenal Cushing's syndrome (CS) and the features which distinguish it from adult CS.


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