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Forum Name: Endocrinology Topics

Question: Surgery questions concerning diabetes


 scholarshipmom57 - Wed Mar 17, 2004 3:46 pm

I discovered yesterday that I will be having surgery soon. They found a mass in my adrenal gland that is around 2" in diameter. My doctor says it has not invaded any other area. I had an ultrasound, catscan, blood work, 24-hour urine, and an MRI. The radiologist that read my tests said that the mass was suspicious looking. I am scheduled for a biopsy of it to find out conclusively whether it is a benign tumor or cancer. The surgeon will do an adrenalectomy (laparoscopic if it is benign tumor, actual cut if it is cancer), then he will take out my gall bladder. After he is done, the gynecologist will come in to perform a complete hysterectomy on me.

My concerns that I am writing about deal with my diabetes. I have been working very diligently to get my blood sugar readings under control. I have lost 30 lbs. over the last five months by eating better and exercising each day. My insulin intake has dropped a great deal, and my blood sugar readings have also improved. I rarely have readings out of the normal range now.

How will all of this affect my diabetes and my blood sugar readings? Will more medication be required? Will my readings become elevated? I do not see an endocrinologist--would you recommend I involve one?

Any advice or information concerning my diabetes or the surgery would be much appreciated.
 Dr. Yasser Mokhtar - Sat Mar 20, 2004 9:24 am

User avatar Dear Scholarshipmom57,

Thank you very much for using our website.

i am very pleased to see more people taking actions regarding their health, because it is their life.

i think that most probably your doctor explained to you that there are sometimes were adrenal gland masses are found incidently on ct scans and the significance of those is not really known and they are called incidentalomas. Usually, radiologists are very good at identifying these incidentalomas. Your doctors did things the right way and checked for activity of this tumour since it looked suspicious.

Diabetes and adrenal glands are a very tricky item.

First some tumours of the adrenal glands can cause diabetes by secreting some of the hormones.

If this tumour was secreting a hormone that was causing diabetes, once the tumour is out, diabetes should be cured, but from your story, i doubt that.

Surgeries are usually a stressful situation and during stresses, there are certain hormones that the body will secrete that will make your diabetes control difficult.

The adrenal glands secrete cortisol which causes high blood sugar as well. One of your adrenal glands is coming out, i am not sure about that but i think that the time that the other adrenal gland takes to compensate for the absence of the other adrenal gland is relatively short.

Cortisol is an essential hormone and i am not sure about the protocol that the endocrinologists use to replace the hormones of one adrenal gland because i have not been exposed to that many cases of removal of one adrenal gland only.

i think they supply you with steroids (which will make your diabetes control worse, but this will be treated by insulin) in the immediate post-operative period and do a certain test which will show whether your other adrenal gland is working adequatly or not. If it then there will be no need for steroid replacement, if it is not, then they will supply you with physiological doses of steroid which should not really affect your diabetes and even if it does, you will just have to increase your insulin.

In addition to the stress of surgery, you will not be doing your usual activities or eating as you are at home, so the control is going to be a day by day thing. And during your hospitalization you will be checked a lot for blood sugars because doctors are now very diligent about diabetes control as well.

Regarding your diabetes control after all the stress of surgery is gone, you are back to your base line activity level and eating habits at home, you will be able to control your blood sugars the way you are doing now.

i assume that the doctor that you are following with for your diabetes is an internal medicine doctor. Regarding involving an endocrinolgist in your care will most probably be up to the surgeons and your internal medicine doctor who will most probably be taking care of you during your hospitalization because of your diabetes. If your internal medicine doctor feels comfortable enough dealing with this type of situation, then there is no need for an endocrinologist, if he thinks it is going to be in your best interest to consult an endocrinologist, they will do it. It is also upto you if you want to consult an endocrinologist, you can ask your surgeons to involve one in your care. Personally, i think that an endocrinologist should be involved before the decision of taking out your adrenal gland is taken as endocrinologists usually have lots of experience with this type of tumours.

Good luck with your biopsy and keep us posted.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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