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Endocrinology consultation before surgery
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The inspiration for this post came from a previous comment and subsequent email.
I once saw a patient who had an enlarged pituitary incidentally discovered on MRI. She was sent directly to the neurosurgeon and underwent transphenoidal pituitary resection. She did not see an endocrinologist and did not have biochemical evaluation of the hypothalamic-pituitary axis until after her procedure. Only later was it discovered that her thyroid-stimulating hormone was over 50. She had pituitary hyperplasia due to primary hypothyroidism. The treatment should have been thyroid hormone replacement — not surgery.
Another patient was sent to me for persistent hypercalcemia after a “failed” parathyroidectomy. Other family members also had persistent hypercalcemia after parathyroid surgery. None had seen an endocrinologist or had preoperative 24-hour urine calcium collection. They all turned out to have familial hypocalciuric hypercalcemia.
I cannot remember how many individuals I have seen who have had their osteoporosis managed solely by vertebroplasty and hip repair. Despite clearly having skeletal fragility, DXA is not ordered, evaluation for secondary causes is not performed and medical treatment is not considered.
Too often, patients are sent directly to interventional specialists. They do not see an endocrinologist for evaluation beforehand. Occasionally, this results in un-needed procedures and surgery. Some continue to have recurrent events, yet are still not sent for consultation. The interventionalists are more than happy to repeat their procedures. They certainly get paid well for what they do. As long as the surgery goes well and without complication, the patient never knows anything different.
Meanwhile, everyone complains about the high cost of medical care.
My experience is not an isolated one. A sad fact is that many patients do not realize that seeing an endocrinologist for a second opinion is an option until after they have already had surgery. I do not have a solution for this problem, other than to continue advocating for endocrinology as a subspecialty and for cognitive medical care in general.