History of Endocrine Surgery

Early beginnings - the history of endocrine surgery

Most would agree that endocrine surgery began with the Swiss surgeon Theodor Kocher (1841-1917).

• Read Theodor Kocher's biography

Kocher's contributions built on the work of Louis Pasteur (1822-1895) and Joseph Lister (1827-1912).

• Read about Louis Pasteur's pioneering studies on infectious diseases
• Read about Joseph Lister's application of antiseptic principle in surgery

During his career, Kocher was able to reduce the death rate following thyroid surgery from approximately 50% to 1% - truly a remarkable feat. Many of these deaths were caused by infection, a process that had not been well understood prior to this era.

Kocher's groundbreaking work on the physiology, pathology and surgery of the thyroid gland culminated in his receipt of the Nobel Prize. A large number of surgical instruments and techniques that remain in current use bear his name.

• Kocher is awarded the Nobel Prize in Physiology or Medicine in 1909

Endocrinology and endocrine surgery

Though knowledge of the existence of endocrine glands dates back to antiquity, understanding of their function only began during the late 1800s. The exocrine glands of the body (those that release their secretions through a duct, such as the salivary glands) possessed an obvious product and purpose. The function of the endocrine (ductless) glands remained mysterious until a number of investigators demonstrated that glandular extracts were capable of curing certain disease states, such as myxedema (now known as hypothyroidism, first treated with thyroid extract in 1891), Addison’s disease (adrenocortical deficiency, first treated with adrenal extract in 1896), and later diabetes mellitus (insulin deficiency, first treated successfully with pancreatic extract in 1922).

The term “hormone” (from the Greek hormao: “to excite”) entered the English lexicon in 1905 when renowned British physiologists William Bayliss (1860-1924) and Ernest Starling (1866-1927) discovered secretin, a compound from the intestine that functioned as a chemical messenger when injected into the bloodstream. Through these events, the field of endocrinology emerged.

Rather than channeling their secretions through ducts, the endocrine glands were discovered to release minute amounts of hormone directly into the bloodstream. As biochemical techniques evolved, individual hormones were purified and characterized throughout the 20 th century and into present day. Notable landmark achievements include:

• 1893 – George Oliver and Edward Schäfer discover that adrenal gland extract, when injected into the bloodstream, raises blood pressure. The active agent, adrenaline (epinephrine), is isolated shortly thereafter.
• 1915 – Walter Cannon uses the term “fight or flight” response to describe the mammalian reaction to physical threats.
• 1922 – Frederick Banting, Charles Best, and John Macleod isolate insulin from canine (dog) and bovine (cow) pancreas.
  • Insulin is used to treat children with type 1 diabetes, rapidly restoring these previously gravely ill children to relatively normal health
  • Banting and McLeod are awarded the Nobel Prize in Physiology or Medicine in 1923, just one year later
• 1936 – Hans Selye builds upon Cannon’s work and describes the stress response. He is widely regarded as the father of stress science. Further studies reveal that the hormonal events underlying the stress response originate in the brain and then involve the pituitary gland and adrenal glands in a cascade fashion. Selye terms this the hypothalamic-pituitary-adrenal axis.
• 1934-1949 – Edward Kendall and Tadeus Reichstein isolate several active hormones (steroid hormones) from the adrenal cortex. Philip Hench uses one of these, cortisone, to treat patients with rheumatoid arthritis successfully.
  • Kendall, Reichstein, and Hench are awarded the Nobel Prize in Physiology or Medicine in 1950
• 1952 – Charles Huggins discovers that the growth of certain cancers is supported by hormones, and that surgically removing the source of the hormones can lead to cancer regression.
  • Huggins is awarded theNobel Prize in Physiology or Medicine in 1966
• 1956-1971 – Roger Guillemin and Andrew Schally painstakingly isolate the peptide hormones of the brain. These small proteins, present in exceedingly tiny quantities, form the basis of the hypothalamic-pituitary-adrenal axis and other hormonal cascades, representing the link between consciousness and endocrine physiology. Their discoveries are made possible by the work of Rosalind Yalow and Solomon Berson, who develop the radioimmunoassay. This new testing method is capable of detecting substances at concentrations of several parts per million to several parts per billion.
  • Guillemin, Schally, and Yalow are awarded the Nobel Prize in Physiology or Medicine in 1977

Collectively, these discoveries enabled physicians to recognize, diagnose, and treat:

• Disease states resulting from hormone excess, managed with endocrine surgery or medicines to inhibit (block) hormone action.
• Disease states resulting from hormone deficiency, managed with pharmacologic hormone supplementation.

1. Welbourn RB: The emergence of endocrinology. Gesnerus, 49 Pt 2: 137-150, 1992.