General, Breast and Endocrine Surgeons
Advanced Laparoscopic Surgery

Have Questions? Please Get In Touch
(602) 843-8317 | Se habla Español.

  • Image of Dr. Agapay, Dr. Friese and Dr. Glenn
  • Image of Dr. Agapay, Dr. Friese and Dr. Glenn's Office
  • Image of Dr. Agapay, Dr. Friese and Dr. Glenn's Office
  • Image of Dr. Agapay, Dr. Friese and Dr. Glenn's Office
  • Image of Dr. Agapay, Dr. Friese and Dr. Glenn

Endocrine Conditions

The endocrine system provides our bodies with the hormones we need for healthy metabolism, sleep, mood, sexual function, growth, and reproduction. In short, we need a healthy endocrine system for a healthy body and good quality of life.

If you have a medical condition that affects your endocrine system, Doctors Allen A. Agapay, William R. Friese and Jordan J. Glenn can help. This team of surgeons provides compassionate, skilled endocrine care using minimally invasive procedures that speed healing, minimize pain and scarring, and optimize positive outcomes.

Thyroid Condition

The thyroid produces hormones that help regulate metabolism. It is located in the neck, just below the thyroid cartilage (commonly known as the Adam’s apple). Thyroid disease is very common and usually involves overactive glands (hyperthyroidism) that produce too much thyroid hormone, or underactive glands (hypothyroidism) that produce too little thyroid hormone.

Conditions that may require thyroid surgery include:

  • A nodule or cyst on the thyroid
  • An overactive thyroid gland
  • Thyroid cancer
  • Benign thyroid tumors that are making it hard to breathe or swallow

Symptoms

  • Fatigue
  • Mood swings
  • Weight gain
  • Weight loss
  • Lump in the neck

Diagnosis

  • Thyroid ultrasound: A painless, non-invasive test in which soundwaves are used to create an image of the thyroid gland and any enlarged lymph nodes in the area. The ultrasound shows the physician the size, location, and characteristics of nodules within the thyroid gland.
  • Fine-needle aspiration (FNA) biopsy: A very fine needle is inserted into the lump to withdraw a small sample of tissue for examination under a microscope. This test will help your doctor determine if the nodule is benign or malignant.
  • Magnetic resonance imaging (MRI) or Computed tomography (CT scan): These non-invasive, advanced imaging tests may be needed to see if an enlarged thyroid is pushing into other vital structures in the neck.

Treatment

Surgery is often recommended for patients with thyroid cancer or hyperthyroidism that is not relieved by medication. Doctors Agapay, Friese and Glenn are experienced in treating thyroid conditions with the most current and minimally invasive techniques.

  • Thyroidectomy: The procedure involves removing the entire thyroid gland. It is performed in a surgical facility under general anesthesia and most patients are able to go home the same day.
  • Thyroid lobectomy: This procedure involves removing the side of the thyroid that has the nodule or tumor. It is performed in a surgical facility under general anesthesia and most patients are able to go home the same day.

Parathyroid Conditions

The four parathyroid glands are about the size of a grain of rice and are located in the neck, near your thyroid gland. They release the hormone that regulates calcium metabolism. Parathyroids produce a parathyroid hormone (PTH) that regulates levels of calcium in the bones and urine. Balanced calcium levels are necessary for the proper functioning of the kidneys, bones, nervous system and heart.

Symptoms

  • Depression
  • Fatigue
  • Muscle cramps
  • Confusion, memory loss
  • Bone pain or fractures
  • Heartburn (GERD)
  • Heart palpitations, high blood pressure
  • Kidney stones

Diagnosis

  • Sestamibi parathyroid scan: A small amount of a safe radioactive material is injected into a vein, and is absorbed by the overactive parathyroid gland. An X-ray image of the chest, neck and head then allows the doctor to identify which gland(s) are overactive based on their reaction to the injected material.
  • Parathyroid ultrasound: A test using soundwaves to create an image of the parathyroid glands. Normal parathyroid glands are usually too small to see on ultrasound, but enlarged abnormal parathyroid glands can be seen by ultrasound.

Treatment

Surgery is recognized as the best treatment for an abnormal parathyroid gland. Calcium imbalance in the body is a serious condition. Too little calcium in the bones can cause osteoporosis. Too much calcium in the blood can cause kidney stones, psychological problems, and can have negative effects on the heart.

Doctors Agapay, Friese and Glenn are experts in providing care for patients with parathyroid disorders. They perform minimally invasive techniques that offer excellent outcomes while minimizing scarring, pain and recovery time.

Minimally invasive parathyroid surgery (MIRP) or focused parathyroidectomy: Using a scope through a small incision in the side of your neck, the surgeon removes only the gland(s) that has been identified as diseased in pre-operative tests.

Standard parathyroid surgery: The diseased parathyroid gland(s) is identified and removed through a 2 to 3 inch incision in the lower part of the neck.

Adrenal Conditions

The adrenal glands are located atop the kidneys and produce hormones, that are critical to regulating blood pressure; metabolism, stress responses and sex hormones.

Symptoms

Patients with adrenal disorders will exhibit a variety of symptoms depending upon the condition they have.

Pheochromocytomas: Symptoms include high blood pressure and can include headaches, excessive sweating, anxiety or panic attacks, and rapid heart rate.

Hyperaldosteronism: Aldosterone producing tumors cause high blood pressure and low potassium levels. In some patients this may result in symptoms of weakness, fatigue, headaches, muscle cramping, and frequent urination.

Cushing's Syndrome: Cortisol producing tumors cause a condition characterized by upper body obesity, high blood sugar, high blood pressure, menstrual irregularities, skin problems like acne or stretchmarks.

The most common symptoms of adrenal insufficiency are:

  • Chronic or long lasting fatigue
  • Muscle weakness
  • Loss of appetite
  • Weight loss
  • Abdominal pain

Diagnosis

  • Hormonal blood and urine tests: These lab tests can identify levels of cortisol and other indicators such as adrenocorticotropic hormone, catecholamines, aldosterone and potassium.
  • Imaging tests: If your doctor suspects a disorder of your adrenal gland, he may use CT or MRI scans to get an image of the gland and identify if an abnormality is present.

Treatment

Patients with adrenal tumors that secrete excess hormones or appear malignant usually require surgical removal of the adrenal gland. Doctors Agapay, Friese and Glenn will perform the most minimally invasive techniques necessary to provide patients with the best outcome and the least amount of disruption to their lives.

Laparoscopic Adrenalectomy

In this minimally invasive surgery, three or four small incisions are made in the abdomen. Then a tiny camera is inserted into an opening, and instruments are used to remove the adrenal gland.

Open Adrenalectomy

When a very large adrenal tumor needs to be removed, the physicians may recommend traditional surgery, which requires a larger incision through the abdomen, flank, or back.

Pancreatic Neuroendocrine Conditions

The pancreas is a gland about six to eight inches long that lies behind the stomach and in front of the spine. The endocrine portion of the pancreas secretes several hormones including insulin, glucagon, somatostatin, and gastrin.

Symptoms

When pancreatic neuroendocrine tumors develop, they may overproduce hormones. The tumors can produce a wide range of symptoms dependent on the type of hormone being over-secreted.

Too much gastrin may cause:

  • Stomach ulcers that keep coming back
  • Pain in the abdomen, which may spread to the back.
  • Gastroesophageal reflux
  • Diarrhea
  • Gastric bleeding

Too much insulin may cause:

  • Low blood sugar
  • Fast heartbeat
  • Mood changes or psychological problems

Too much glucagon may cause:

  • Skin rash on the face, stomach, or legs
  • High blood sugar
  • Blood clots
  • Diarrhea
  • Weight loss for unknown reason
  • Tongue or mouth sores

Too much vasoactive intestinal peptide (VIP) may cause:

  • Very large amounts of watery diarrhea
  • Dehydration
  • Low potassium level in the blood
  • Cramps or pain in the abdomen
  • Weight loss for unknown reason

Too much somatostatin may cause:

  • High blood sugar
  • Diarrhea
  • Very foul-smelling stool that floats
  • Gallstones
  • Yellowing of the skin and whites of the eyes
  • Weight loss for unknown reason

The most common symptoms of adrenal insufficiency are:

  • Chronic or long lasting fatigue
  • Muscle weakness
  • Loss of appetite
  • Weight loss
  • Abdominal pain

Diagnosis

  • Endoscopic ultrasound: This procedure uses a thin tube called an endoscope that is inserted through the mouth or rectum and uses soundwaves to create an image of the internal organs and tissues that your doctor can use to diagnose.
  • Abdominal CT scan: In this procedure, an x-ray machine sends pictures of your abdomen to a computer so they can be viewed by your doctor. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
  • Somatostatin receptor scintigraphy: A small amount of a hormone that attaches to tumors is injected into a vein. The hormone then attaches to the tumor and a special camera that detects radioactivity is used to show where it is.
  • Magnetic resonance imaging (MRI) This non-invasive, imaging procedure uses radio waves to produce a detailed picture of areas inside your body.

Treatment

Which surgical procedure is performed depends on the type of tumor, its size, and its location in the pancreas. Doctors Agapay, Friese and Glenn will work with you to provide the best option for your unique needs. Surgical options include the ones listed below.

Enucleation: In this minimally invasive surgical procedure, just the tumor is removed through a small incision.

Pancreatoduodenectomy (Whipple procedure): The head of the pancreas, the gallbladder, parts of the stomach and small intestine, and nearby lymph nodes are removed. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive juices and insulin will continue to produce.

Distal Pancreatectomy: In this procedure, the body and tail of the pancreas are removed while the head of the pancreas is preserved. The laparoscopic procedure is performed through several small incisions using a tiny camera, a thin scope and laparoscopic instruments.