The Endocrine Tumor Treatment Center is a combination of doctors including specialists in each field.
We provide the best medical care from diagnosis to treatment for endocrine organs.
Specialist / doctor belonging to this hospital
- Endocrine Society specialists
- Thyroid Society specialists
- Specialist of the Japan Neurosurgery
- Urology Society specialists
- Hepatobiliary and Pancreatic Surgery Society specialists
Organization / system diagram
Background and purpose of establishment
The number of patients with endocrine tumor diseases (total of thyroid malignancies, benign nodules of the thyroid gland, adrenal tumors, and pituitary tumors) exceeded 22,000 in FY2018, an increase of 10% compared to FY2016.* 1 In addition, the number of patients at our hospital has increased by 20% compared to the same period, which is higher than the national increase rate. * 2.
On the other hand, although the tumor is discovered, the appropriate clinical department is different such as Cerebral Surgery, Otorhinolaryngology, Digestive Surgery (internal medicine), Urology, and Obstetrics ＆ Gynecology. The department in charge of the referral of the facility is different, so the issue was that there were few facilities that could seamlessly perform surgery and postoperative management.
Based on this background, We have decided to launch "Endocrine Tumor Treatment Center" in order to establish a system to provide optimal medical care to each individual by promoting seamless cooperation with the Surgery clinical department for patients who are a candidate for surgery, and diagnosis and specialized treatments by a specialist of the Endocrinology Society.
- From FY2016-FY2018 DPC public data
- Our hospital investigation
Endocrine tumors include tumors of various organs such as the betweenbrain / pituitary gland, thyroid gland / parathyroid gland, pancreas / gastrointestinal tract (neuroendocrine tumor), adrenal gland, and gonad. Due to the progress of diagnostic imaging recent years and increase in frequency for image inspection, the number of discoveries and diagnoses has increased dramatically. Even found these tumors, Cerebral Surgery, Otorhinolaryngology, Digestive Surgery (internal medicine), Urology, Obstetrics ＆ Gynecology, such as the the clinical department is different, and challenge is that department be in charged are different depending on referral facilities .
Furthermore, there are few facilities where endocrinologists and thyroid specialists belong and can seamlessly perform surgery and postoperative management when necessary under endocrinological management.
Against this background, the "Endocrinological Tumor Treatment Center" was established aims to provide more accurate and prompt diagnosis and treatment by centrally taking charge of endocrinological evaluation and surgical indication of the above tumors excluding gonads.
We will explain the diseases supported by the Endocrine Tumor Treatment Center.
The pituitary gland resides in a bone depression called the sella turcica in the midline of the basilar. It is a very small brain tissue with a size of 7 to 8 mm and a weight of about 700 mg, and produces various hormones that act on each organ of the human body.
It is divided into anterior and posterior lobes, and the following hormones are mainly secreted.
- Anterior lob
- Adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH), growth hormone (GH), galactopoietic hormone (prolactin; PRL), gonadotropin (LH and FSH)
- Posterior lob
- Antidiuretic hormone (ADH / vasopressin (AVP))
Pituitary tumors (adenomas) are typical diseases that occur in the pituitary gland. It is mainly caused by hormone overproduction (hormone-producing pituitary adenoma) from anterior lobe tumors and causes various diseases. The typical diseases are shown below.
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Acromegaly (growth hormone-producing tumor)
Growth hormone (GH) is a hormone produced by the anterior pituitary gland. In childhood, it is a hormone necessary for the growth and growth of bones, cartilage, muscles, organs, etc., and for cholesterol metabolism, muscle / fat balance, mental activity, etc. even in adults.
Acromegaly (growth hormone-producing tumor) is a disease in which the effects of growth hormone cause overgrowth of various tissues, resulting in hypertrophy of limbs and changes in facial appearance. Pituitary gigantism occurs before pubertal epiphyseal closure, and acromegaly occurs after closure.
In addition to symptoms such as protrusion of the forehead and lower jaw, enlarged nose wings, lips, and tongue, increased size of rings and shoes due to increased limbs, snoring, and excessive sweating, life such as diabetes and hypertension It can cause lifestyle-related diseases and is often noticed as "snoring or rings do not fit" or "diabetes or hypertension develops or worsens". Excessive growth hormone also increases the incidence of malignant tumors.
Surgery is the first choice for treatment, but if the tumor is too large, if it cannot be removed by surgery alone due to the degree of invasion to the surroundings, or if surgery is difficult, medical treatment with injections or oral medications may be used. Combined with radiation therapy, it controls growth hormones to stay in the normal range.
Cushing's disease (ACTH-producing tumor)
Cortisol, an adrenocorticotropic hormone, is a hormone produced and controlled by stimulation of adrenocorticotropic hormone (ACTH) from the anterior pituitary gland, and is one of the most necessary hormones for maintaining vital activity. It acts on the tissues of the whole body to control sugar, lipid, protein, bone metabolism and immune function.
Cushing's disease is caused by persistent overproduction of ACTH, resulting in continued high levels of cortisol in the blood, causing Cushing's symptoms such as full moon-like facial features, buffalo-like shoulders, central obesity, red skin streaks, and hirsutism, as well as diabetes. It is a disease that causes or exacerbates lifestyle-related diseases such as hypertension, dyslipidemia, and osteoporosis. It is often found in uncontrolled hypertension, diabetes, dyslipidemia, and osteoporosis, and treatment may cure lifestyle-related diseases.
Surgery is the first-line treatment, but because the tumor is small and often difficult to detect, if surgery does not cure or surgery is difficult, medical treatment with injections or oral medications or radiation therapy Combined with therapy, cortisol is controlled to stay in the normal range.
Prolactin (PRL), which is secreted from the anterior pituitary gland, is a hormone required for postpartum lactation. Among pituitary tumors, tumors that overproduce the hormone prolactin are called prolactin-producing tumors.
Excessive prolactin can cause lactation not only in women but also in men, causing menstrual irregularities and infertility in women, and causing symptoms such as hypogonadism in men. It is a disease that is often found inside. Although the tumor is often relatively large, it is often possible to control prolactin to the normal range by medical treatment with oral medicine, and it is often the case that the tumor shrinkage effect can be seen only by medical treatment. Surgery may be indicated if symptoms such as headache and visual field loss are present.
Accidental pituitary tumor (incidentaloma)
Accidental pituitary tumor (incidentaloma) is an image performed for reasons other than "chronic headache, dizziness, head trauma, symptoms due to pituitary tumor such as medical examination (abnormal vision, hypopituitarism, etc.)" It is defined as a pituitary tumor or mass lesion found by chance on examination (CT, MRI, etc.).
Pituitary tumors that do not show overproduction of the hormones listed above are called non-functional pituitary tumors (adenomas). Since non-functional pituitary tumors are benign tumors, they are often followed up if there are no symptoms, but if the tumor is large, symptoms such as headache and visual field loss as symptoms of pressure on the surroundings and pituitary hormone secretion Due to hypopituitarism (hypopituitarism), each hormone is deficient.
Surgery may be indicated if there are pressure symptoms. In addition, if decreased pituitary hormone secretion is observed even in the absence of compression symptoms, secondary adrenocorticotropic disorder or pituitary thyroid gland due to insufficiency of ACTH (adrenocorticotropic hormone) or TSH (thyroid stimulating hormone) secretion. If hypofunction is present, regular follow-up is indicated. If left untreated, when a great deal of stress is applied to the human body such as surgery or infectious diseases, there is a possibility of developing adrenal crisis or thyroid crisis that causes multiple organs to malfunction, which is also a life-threatening situation. Yes.
Thyroid tumor (nodule)
The thyroid gland is located between the thyroid cartilage (Adam's apple) in the anterior neck and the sternocleidomastoid muscles on both sides. It is an organ weighing 16 to 20 g and measuring 4.5 x 4 cm. It looks like a butterfly when viewed from the front, and produces thyroid hormone, which is essential for life activities. Thyroid tumors can be benign or malignant.
- Follicular adenoma, adenomatous goiter, cyst, etc.
- Papillary cancer, follicular cancer, medullary cancer, poorly differentiated cancer, undifferentiated cancer, etc. (malignant lymphoma, etc.)
The most common adenomatous goiter in the entire thyroid nodule is often follow-up only and requires no special treatment. On the other hand, papillary cancer, which accounts for more than 90% of all malignant tumors (thyroid cancer), has a relatively good prognosis, but undifferentiated cancer with a poor prognosis also exists in 1 to 2%.
If a tumor is found in the thyroid gland, an ultrasound is done first. After that, fine-needle aspiration cytology is performed as a detailed examination to distinguish between benign and malignant tumors, but some nodules are difficult to diagnose by fine-needle aspiration cytology, so cancer may be diagnosed after surgery.
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Benign tumor (nodule):
Adenomatous goiter, thyroid cyst, follicular adenoma
It is a nodule that is often found by palpating or pointing out a nodule in the thyroid gland by medical examination, self-palpation, or ultrasound of the carotid artery. Benign nodules include adenomatous goiter, thyroid cysts, and follicular adenomas.
If it is a benign nodule, it will not affect your life so much if you leave it as it is, but if the nodule is large, it can be removed by surgery. In addition, there are some cases where suspicion of hormone production or malignancy cannot be ruled out, and in that case, surgery may be indicated after close examination.
Thyroid cancer (papillary cancer, follicular cancer, medullary cancer, undifferentiated cancer)
Among those found by palpating and pointing out nodules in the thyroid gland by medical examination, self-palpation, or ultrasound of the carotid artery, some nodules are diagnosed as malignant and are called thyroid cancer. .. Surgery is the first choice for treating thyroid cancer.
However, if multiple metastases have already been found, or if anaplastic thyroid cancer is not indicated for surgery, anticancer drugs or isotope treatment may be selected.
|Thyroid tumor surgery||29||33||35||39|
|year||Thyroid tumor surgery|
The parathyroid gland is an organ that secretes parathyroid hormone (PTH), which is the size of a rice grain, behind the thyroid gland, and has a total of 4 glands on the top, bottom, left, and right. PTH is a hormone that balances calcium in the body and acts on bones and kidneys to balance calcium in the blood.
Primary hyperparathyroidism (adenoma, hyperplasia, cancer)
Primary hyperparathyroidism is a disease that causes hypercalcemia and hypophosphatemia due to the overproduction of parathyroid hormone due to the enlargement of the parathyroid gland due to adenoma, hyperplasia, and cancer in the parathyroid gland. is.
More than 80% are benign adenomas, often found as asymptomatic hypercalcemia, but may also be found due to heavy drinking / polyuria, kidney stones, urinary tract stones, and renal dysfunction. Depending on the degree of hypercalcemia, there are various symptoms such as neurological / muscular symptoms such as leaning / coma and muscle weakness, gastrointestinal symptoms such as nausea / vomiting, digestive ulcers and pancreatitis, and cardiovascular symptoms such as electrocardiographic changes and arrhythmia. It may appear and develop intractable osteoporosis if left untreated for a long period of time.
Surgery for swollen parathyroid glands is the first-line treatment, but if surgery is difficult, medical treatment with oral medication is given.
Secondary hyperparathyroidism (during dialysis therapy, etc.)
Parathyroid hormone is the most important hormone that regulates calcium in the blood, and when hypocalcemia occurs due to other causes such as dialysis, parathyroid hormone responds in an attempt to correct it. Hypersecretion occurs. In this way, the cause of the disease is not the parathyroid gland itself, but other than the parathyroid gland, and as a result, the pathological condition in which parathyroid hormone increases secondarily and calcium is lost from the bone is called secondary hyperparathyroidism. I call.
The principle of treatment is elimination of the cause, but elimination of the cause is not possible during dialysis therapy associated with chronic renal failure, and surgery may be indicated from the viewpoint of aggravation of osteoporosis and prevention of ectopic calcification. ..
The adrenal gland is an organ of about 5 to 8 g located on the upper ventral side of both kidneys, and is divided into a superficial cortex and a central medulla. The following hormones are produced from the cortex and medulla, respectively.
- Corticosteroids (cortisol, aldosterone, androgens)
- Catecholamines (adrenaline, noradrenaline, dopamine)
Most of these adrenal hormones are essential for life activities. Insufficiency can lead to fatal conditions due to adrenal insufficiency, while overproduction can cause a variety of illnesses.
More than half of adrenal tumors are benign adrenal adenomas without hormone overproduction, but one-third have hormone overproduction and develop various symptoms and are indicated for surgery. In addition, adrenal gland cancer is extremely rare, but it is a disease with a poor prognosis, and accurate diagnosis and early treatment are required.
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Adrenal accidental tumor
Adrenal accidental tumor is an adrenal tumor that was accidentally found by imaging tests performed without assuming adrenal-related diseases, and is found with a probability of about 3% of all abdominal CT. Of these, non-functional adenomas with no hormone overproduction account for more than half, and if the size of the tumor is less than 4 cm, regular imaging and hormone tests are performed to determine whether the tumor is growing and hormones. Check for the appearance of overproduction and follow up.
Clear medical care standards have not yet been established in Japan, and our center will also provide accurate medical care centered on the staff of the medical care standard formulation committee.
Functional adrenal adenoma (primary aldosteronism / Cushing's syndrome)
Functional adrenal adenomas are the main tumors of primary aldosteronism and Cushing's syndrome.
Primary aldosteronism is a disease in which hypertension is caused by the excessive secretion of a hormone called aldosterone. It is known that excessive production of aldosterone from tumors in the adrenal cortex causes hypertension and hypokalemia, and is also involved in the onset and exacerbation of diabetes. Primary aldosteronism often results in intractable hypertension, accounting for less than 10% of total hypertension. Some of them are surgical indications.
It has been reported that blood pressure control with general antihypertensive drugs alone significantly increases the incidence of stroke, angina, myocardial infarction, and arrhythmia. In particular, it corresponds to hypokalemia, young people, 160/100 mmHg or more, treatment-resistant hypertension, complications of adrenal accidental tumors, onset of cerebrovascular accidents under 40 years old, impaired glucose tolerance, obesity, sleep apnea syndrome, etc. Those are considered to be in the high-risk group and require active testing. It is indicated for surgery, and if surgery is performed, hypertension may be completely cured. People with hypertension need to be tested once.
Cushing's syndrome is a condition caused by the overproduction of cortisol, an adrenocortical hormone, by an adrenal tumor. Cortisol is one of the most necessary hormones for maintaining vital activity, and acts on tissues throughout the body to control sugar, lipid, protein, bone metabolism and immune function. However, its overproduction causes Cushing's symptoms such as moon face, buffalo shoulders, central obesity, red skin striae, and hirsutism, and causes or worsens lifestyle-related diseases such as diabetes, hypertension, dyslipidemia, and osteoporosis. I will also let you. It is often found in uncontrolled hypertension, diabetes, dyslipidemia, and osteoporosis, and treatment may cure lifestyle-related diseases. Surgery is the first-line treatment, and endoscopic surgery is common, but if surgery is difficult, medical treatment with oral medication may be used to control cortisol.
Adrenal cancer is a rare tumor with a poor prognosis at 1.4% of all adrenal tumors. Often found as Cushing's syndrome or as adrenal accidental tumor.
Generally, it is often found as a huge adrenal tumor, and at the time of discovery, multiple metastases may have already occurred. Even if there is no metastasis before surgery, metastasis is often found after surgery, and postoperative anticancer drug treatment is also required.
In addition, even if a non-functional adrenal adenoma is diagnosed at the time of discovery, the diagnosis may change to adrenal cancer during subsequent follow-up, and strict follow-up is required. Medical treatment is desirable.
Pheochromocytoma is a tumor that develops in the adrenal medulla and surrounding ganglia. Due to overproduction of catecholamines, various clinical situations such as hypertension, motivation, tachycardia, chest pain, headache, pallor of the face, sweating, anxiety, and hyperglycemia Symptoms appear.
Pheochromocytoma accounts for 0.1-0.6% of all hypertensive patients, which is a relatively rare disease, and about 65% of pheochromocytoma patients are diagnosed with hypertension. In addition, there are three types of pheochromocytoma: seizure type, in which blood pressure fluctuates drastically, persistent type, which presents persistent hypertension, and mixed type, which consists of a combination of the two. Each occurs about 1/3 of the time, but 35% are asymptomatic with no symptoms.
In recent years, it has become more common to be found as adrenal accidental tumors, and it has been reported that 8.5% of adrenal accidental tumors were pheochromocytomas. In addition, about 10% each of extraadrenal, bilateral, and malignant, genetic abnormalities are found in up to 60%, and at least 18 types of related gene mutations have been reported. During the course, hypertensive emergency may develop due to various triggers such as forward bending posture, exercise, squeezing, urination / defecation, abdominal examination, iodine contrast agent test, and some drugs. It develops complications and has a poor prognosis.
Surgery is the treatment of choice and generally has a good postoperative course, but in rare cases multiple metastases may already be present at diagnosis. In that case, chemotherapy with anticancer drugs and radiation therapy are indicated.
Pheochromocytoma has recently been positioned as a latent malignant tumor with the possibility of metastasis by WHO, and it is necessary to follow up for a lifetime after surgery.
|Adrenal tumor surgery||14||8||6||twenty three|
|year||Adrenal tumor surgery available|
Pancreatic / gastrointestinal neuroendocrine tumor
Neuroendocrine tumors (NENs) that occur in the digestive tract are relatively rare diseases that occur in 3 to 5 people per 100,000 people annually, most of which occur in the pancreas and gastrointestinal tract.
Some pancreatic and gastrointestinal neuroendocrine tumors are functional (hormone-producing) and may be found due to symptoms of hormone excess. On the other hand, non-functional tumors are often found by chance by abdominal ultrasonography, CT, or upper and lower gastrointestinal endoscopy during medical examinations and scrutiny of abdominal symptoms.
As an Endocrine Tumor Treatment Center, this center provides medical care for functional (hormone hypersecretion) pancreatic and neuroendocrine tumors from the viewpoint of tumor control, and also controls hormone hypersecretion symptoms.
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Insulinoma (insulin-producing tumor)
Insulinoma is a tumor in the pancreas that secretes insulin. It is found by repeated hypoglycemic attacks due to over-secretion of insulin.
The main symptoms are fasting hypoglycemia and seizures, but postprandial hypoglycemia is also possible. Autonomic symptoms include sweating, hunger, tremors, nausea, and palpitation, and central nervous system symptoms include diplopia, coma, abnormal behavior, and forgetfulness. In addition, severe hypoglycemia often leads to impaired consciousness and coma, and irreversible encephalopathy (hypoglycemic encephalopathy) develops when left untreated for a long time.
Surgery is the first-line treatment, but it is often difficult to detect tumors, so if surgery is difficult, insulin secretion should be controlled by using oral medication or injection therapy.
Gastrinoma (gastrin-producing tumor)
Gastrinoma is a gastrin-producing tumor that develops in the pancreas or duodenal wall. It was discovered as a peptic ulcer due to excessive gastric acid secretion associated with overproduction of gastrin from a neuroendocrine tumor, and frequently occurs in the duodenum and air intestine, mainly in the duodenal bulb. To do. The ulcer is characterized by refractory, relapsing, and multiple ulcers and is called Zollinger-Ellison syndrome.
Surgery is the first-line treatment, but it is often difficult to detect tumors, so if surgery is difficult, use oral medication or injection therapy to control gastrin secretion.
- Director of Diabetes and Endocrinology Center
- Manager of Diabetes and Endocrinology
Endocrine / diabetes, primary aldosteronism, secondary hypertension, adrenal gland disease
Board specialist / certified doctor
- Certified by the Japanese Society of Internal Medicine, General Internal Medicine specialist, instructor
- Japan Endocrine Society Endocrinology and Metabolism Specialist / Instructor / Councilor
- Japan Diabetes Foundation Specialist / Instructor
- Japanese Society of Hypertension Regular Member / Instructor
- Japanese Thyroid Society Specialist
- Councilor of the Japanese Society of Steroid Hormones
- Chief physician of Diabetes and Endocrinology
We strive to provide the best medical care for each patient, focusing on endocrine diseases.
Endocrinology / diabetes
Board specialist / certified doctor
- Japanese Society of Internal Medicine Certified Physician / General Internal Medicine Specialist
- Japan Diabetes Foundation Specialist / Instructor
- Japan Endocrine Society Endocrinology and Metabolism Specialist / Instructor
- Japanese Society of Gastroenterological Endoscopy Specialist
- JATEC Provider
Medical table / medical appointment
We will inform you about the medical treatment table and medical treatment reservation of the Endocrine Tumor Treatment Center.
How to get a medical examination
After selecting the desired reservation date and reservation frame,
From patients who have a referral letter or medical institutions where wrote a referral letter, please call below.
Online reservation is also possible.
045-576-3000 (main) (Reception hours 9: 00-16: 00 Saturdays, Sundays, and holidays)Click here for online reservation
- Please offer that it is the "first appointment for the Endocrine Tumor Treatment Center".
Procedures on the day
Please bring your insurance card and referral letter, then come to 12th reception desk on the 1st floor 15 minutes before the reservation time.
Please tell the 12th reception that it is the "first visit to the Endocrine Tumor Treatment Center".
- If you are late for the reservation time, we may have to wait. Note that.
- Referral letter is no need to mail a letter of introduction in advance.
We accept any inquiries regarding endocrine tumors.