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INTRODUCTION Two major systems are held responsible for the regulation of homeostasis of the human body: the endocrine and neuroen docrine systems. Both interact with their target organs or target tissues via secretion of ubiquitous messenger molecules, whic...

Learning objectives Adrenal gland To understand the investigation and diagnosis of disorders • of the adrenal gland To know of the principles and postoperative management • of adrenalectomy Pancreatic endocrine disorders and gastrointestinal neuro endocrine tu...

Metastases Definition Adrenal metastases are not uncommon and often portend - disseminated incurable disease. Primary tumours that commonly spread to the adrenals include lung, renal, gastric, breast and colorectal cancers. The decision regarding surgical inter...

PHYSIOLOGY The outer zona glomerulosa secretes the C21 steroid aldosterone. The zona fasciculata secretes (C21 steroid) cortisol and the inner zona reticularis secretes (C19 steroid) androgens. Aldosterone regulates sodium–potassium homeostasis; it promotes so...

Treatment Medical Metyrapone or ketoconazole therapy reduces steroid synthesis and secretion by CYP11B1 inhibition and can be used to prepare patients with severe hypercortisolism preoperatively or as primary therapy if surgery is not possible. In patients wh...

Acute inflammation of the breast Mastitis refers to inflammation of the breast tissue that may or may not be accompanied by infection. Acute mastitis can occur in lactating as well as non-lactating women, with the former being more common. Lactational (puerperal...

BENIGN BREAST DISEASE Nomenclature The nomenclature of benign breast disease in the past has been confusing owing to the use of a variety of terms – namely , fibrosis, adenosis, epitheliosis, fibroadenosis and fibrocystic disease – for clinical patterns of pa...

Breast cancer in pregnancy Pregnancy is associated with aggressive tumour biology such as TNBC. Ultrasonography of the breast, mammogram and chest radiograph with abdominal shielding of the fetus may be considered. In cases where bone or brain metastasis is ...

CARCINOMA OF THE BREAST Breast cancer is the most frequent cancer among women, with an estimated 2.3 million new cases diagnosed worldwide in 2020, representing about 25% of all cancers in women. Inci dence rates vary widely across the world, from 27 per 100 ...

COMPARATIVE AND SURGICAL ANATOMY The breast in adult females overlies the pectoral region, extend ing from the second rib above to the sixth rib or inframammary crease below . Medially it extends to the lateral border of the sternum and laterally it reaches t...

Carcinoma of the male breast Carcinoma of the male breast ( Figure 58.39 ) accounts for less than 0.5% of cases of breast cancer. The most common symp tom at presentation is a painless subareolar lump. Involvement of the nipple–areolar complex and underlyi...

Clinical features The most common manifestations of ANDI are breast pain and benign nodularity . The breast pain usually follows the menstrual cycle, appearing around day 14 and increasing in severity until day 28, when it becomes severe (cyclical pronounced ...

Clinical presentation A discrete lump in the breast is the most common presentation, and the most common tumour site is the upper outer quadrant of the breast (50% of TDLUs lie there). Other symptoms include nipple retraction, nipple discharge (blood or sero...

Congenital abnormalities Amazia Congenital absence of the breast may occur on one or both sides. It is sometimes associated with Poland’s syndrome, which is characterised by the absence of the sternal portion of the pectoralis major and short webbed fingers ...

Cracked nipple This is observed in about 10% of nursing mothers and is thought to arise from the strong negative force created by suckling. It initiates as a small blister on the nipple that soon ruptures to give rise to a small ulcer. The crack thus formed i...

Discharges from the nipple Most nipple discharges are caused by physiological aberrations as part of ANDI, may emanate from a single or many milk - ducts and may involve one or both sides. The presence of a s ingle, s erous, s anguineous and s pontaneous dis...

Discrete lumps in the breast The main causes of discrete lumps in the breast are listed in Summary box 58.1 . Sometimes a lump appears in the breast evanescent lump . It is caused by an inflammatory mass of periductal mastitis; the lump, pain and tenderness al...

Eczema Eczema of the nipple and areola is a rare condition and is often bilateral; it is usually associated with eczema elsewhere on the body . It is treated with 0.1% betamethasone skin cream by local application and by using moisturising soaps. If the nipp...