What is your role at The London Clinic?

I am a consultant endocrine and general surgeon, and I have been with The London Clinic for almost 25 years. I perform all my surgeries in adult patients exclusively there, but also operate on children at the Great Ormond Street Hospital. I am also an Honorary Associate Professor at UCL.

What is the endocrine system and its functions, and what types of problems may people experience?

The endocrine system is composed of many endocrine cells, most of which form clusters known as endocrine organs. These include the pituitary and hypothalamus in the brain, which act as the ‘directors of the orchestra’, secreting hormones that regulate other hormones. Further down in the body, we have the thyroid and parathyroid glands in the neck, the adrenal glands and the pancreas, which also contains endocrine cells responsible for producing hormones like insulin.

Endocrine surgeons operate on organs such as the thyroid, parathyroids, adrenals and parts of the pancreas. The system plays a crucial role in our physiology – essentially, hormones to a great extent define who we are.

What types of conditions do people present with, and how are they diagnosed?

Patients can present in many different ways First, they may have tumours and if they are malignant – for example, thyroid cancer – cancer cells can spread to the lymph nodes and other parts of the body. Palpable or visible nodules in the thyroid or enlarged lymph nodes in the neck are frequently the first presentation of thyroid cancer. Some endocrine tumours can be tiny, but still create major health issues by overproducing hormones. For example, an overproduction of insulin can lead to dangerously low blood glucose levels, while an adrenal tumour producing too much adrenaline can cause high blood pressure, potentially leading to heart attacks or strokes.

Hormone overproduction disorders can also result in severe metabolic imbalances. For instance, excess cortisol from the adrenal gland can lead to Cushing’s syndrome, while overproduction of aldosterone can cause difficult-to-treat high blood pressure.

What is the typical pathway for patients before they come for surgery?

Most patients are referred by their general practitioner (GP), particularly if they present with a lump in the neck. However, the more complex cases typically come from specialised diagnosis by endocrinologists. Also, many international patients come to The London Clinic through direct referrals by their local physicians, especially from the Gulf region, where we have strong medical connections.

Moving on to surgery, what is the process for thyroid, parathyroid and adrenal gland procedures?

Endocrine surgery is highly guided by specialised blood tests and imaging. We measure specific hormone levels, sometimes stimulating or suppressing them for diagnostic purposes. Imaging is equally important. In addition to standard CT and MRI scans, we use nuclear scans with targeted radiotracers to locate tiny tumours.

Each type of surgery is slightly different. With thyroid surgery, patients usually present with a lump, which may be benign or malignant. Surgery is necessary if the lump is cancerous or large enough to cause breathing difficulties.Patients would typically require only an overnight stay in hospital for this kind of surgery.

With parathyroid surgery, patients typically have a benign tumour in one of their four parathyroid glands, causing excess hormone production that leads to high calcium levels, bone weakening and kidney stones. Imaging and specialised nuclear scans help locate the affected gland before surgery. We also use intraoperative hormone testing during parathyroid surgery to confirm successful removal of the problematic gland within minutes of excision. For such an operation, patients would usually only need to stay in hospital overnight.

Adrenal conditions are complex due to the multiple hormones these glands produce. One of my special interests is aldosterone-secreting tumours, which are often misdiagnosed but can cause high blood pressure that is resistant to standard treatments. Typically, patients stay one or two nights in hospital for their operation, except in cases involving large adrenal cancers requiring more extensive surgery.

What makes The London Clinic unique in endocrine surgery?

We offer state-of-the-art diagnostic and surgical technologies, including intraoperative hormone testing. Our involvement in developing new PET scan tracers for adrenal tumours places us at the forefront of endocrine surgery worldwide.

To learn more about The London Clinic, visit thelondonclinic.co.uk
or contact:
T: +44 (0) 20 4527 8215
E: appointments@thelondonclinic.co.uk

For international patients, contact:
E: internationaloffice@thelondonclinic.co.uk