Highlights from endocrine surgical history

Endocrine surgery includes excision of diseased or sometimes normal endocrine glands and occasionally the transplantation of endocrine tissues. Male castration was performed for social reasons in prehistoric times, and thyroid operations were described during the twelfth century. Until the end of the nineteenth century most operations were undertaken to relieve the local effects of pathologic enlargement of the thyroid, ovaries, pituitary, and adrenals; and with the development of anesthesia, antisepsis, and effective hemostasis, thyroidectomy for benign, nontoxic goiter was perfected. Thyroid deficiency followed total thyroidectomy, and thyroid replacement therapy was developed. Toxic goiter was sometimes relieved by partial thyroidectomy. After the discovery of hormones early this century, knowledge of endocrinology increased, and many syndromes of hormonal excess were described. Surgeons began to operate to relieve them. Results improved with mastery of surgical technique, especially for operations on the thyroid, parathyroids, and pituitary; with the development of methods for diagnosis of syndromes and the localization of lesions; with teamwork; and with the use of hormones, drugs, and radiotherapy as alternative or additional forms of therapy before, during, and after operation. Notable advances followed adequate resection of thyroid tissue and the use of iodine and antithyroid drugs before operation for toxic goiter. The use of cortisone rendered adrenalectomy safe for the relief of cancer of the breast and prostate and of Cushing's syndrome. For about 40 years increasing numbers of surgeons have specialized in endocrine surgery as a discipline within general surgery, and results of treatment have improved greatly.