Scandinavian Quality Register
for Thyroid and Parathyroid Surgery
including Adrenal Surgery
BASIC DATA (Fill in or use patient sticker)
Patients Name: / ______Civic Registration Nr: / -
Age: / ______Years
Type of operation / Primary Reoperation
Hereditary disease / Yes If Yes, type of mutation
RET
MEN 1
VHL
NF1
SDHB
SDHC
SDHD
Other: ______(specify)
No
PREOPERATIVE DATA
CLINICAL DATA
1. Detection
Incidental
Adrenal related symptoms
2. Medical history of treatment for malignancy
Yes If Yes, year for diagnosis of latest malignancy ______
No
3. Symptoms and signs of hormonal excess
Symptoms of cathecolamine excess
Symptoms of cortisol excess
Virilizing/Femilizing
None
4. Pain
Yes / No
5. Weight over three months
Stable weight Lost weight Gained weight
6. Hypertension
Yes No
7. Diabetes Mellitus
Yes No
8.Osteoporosis
Yes No
9. Systolic bloodpressure ______mm/Hg
10. Diastolic blood pressure______mm/Hg
11. Weight______kg
12. Height ______meter
13. BMI______weight kg/height (m2)
PREOPERATIVE BASAL BIOCHEMISTRY
14.Hypokalemia Yes / No
15. tU- epinephrine
normal increased subnormal not performed
16. tU-norepinephrine
normal increased subnormal not performed
17- tU- metoxycatecolamine
normal increased subnormal not performed
18. P-metanephrine
normal increased subnormal not performed
19. P-normetanephrine
normal increased subnormal not performed
20. tU-VMA
normal increased subnormal not performed
21. P-Chromogranin A
normal increased subnormal not performed
22. Aldosteron/Renin ratio
normal increased subnormal not performed
23. Sex steroids
normal increased subnormal not performed
24. tU-cortisol
normal increased subnormal not performed
25. p-ACTH
normal increased subnormal not performed
26. S-DHEAS
normal increased subnormal not performed
27. U-steroids
normal abnormal not performed
Confirmatory biochemical testing
28. Dexametasone suppression test
normal pathological not performed
29. Saltloading
normal pathological not performed
30. FST suppression test
normal pathological not performed
31. Clonidine suppression test
normal pathological not performed
32. Cathapresan test
normal pathological not performed
33. Serum cortisol curve ( over 24 hrs)
normal pathological not performed
Radiology
34. Adrenal CT
Yes If Yes, Houndsfield units before contrast______HU
No
35.Abdominal CT
Yes If Yes, Houndsfield units before contrast ______HU
No
36. MRI
Yes No
37. Adrenal sampling
not performed unilateral gradient bilateral gradient inconclusive investigation
38. MIBG scintigraphy
not performed unilateral uptake bilateral uptake inconclusive investigation
39. Octetrotide scintigraphy
not performed unilateral uptake bilateral uptake inconclusive investigation
40. NP-59 scintigraphy
not performed unilateral uptake bilateral uptake inconclusive investigation
41.PET
not performed unilateral uptake bilateral uptake inconclusive investigation
42. Other
Yes
No / If Yes, state type of investigation:
______
Adrenal tumour after work-up ( staging)
43. Side for adrenal tumour
right left bilateral
44. Largest tumour size______mm
45. Radiological signs of malignancy of primary tumour
Yes No
46. Metastasis
Yes No
OPERATION
Indication for surgery
47. Clinical syndrome of hormonal excess
None
Cathecolamines
Cortisol
Aldosteron
Sex steroids
Other If other, specify clinical syndrome of hormonal excess______
48.Suspected malignancy on radiology
Yes No
49.Size only
Yes No
50.Malignancy ( documented)
Yes No
51.Other indication ( only to be filled in if applicable )______
Preoperative treatment in preparation for surgery
52.Medical treatment due to cathecolamine excess
Yes No
53.Medical treatment due to cortisol excess
Yes No
54. Medical treatment due to hypokalemia
Yes No
55.Medical treatment for hypertension ( except for cathecolamine excess)
Yes No
56.Date of operation ______
Surgical technique
57. Adrenal operation (BCA code)
BCA10 Adrenal biopsy
BCA 11 Laparoscopic adrenal biopsy
BCA 15 Adrenal incision ( including drainage)
BCA 20 Adrenal resection
BCA 30 Unilateral adrenalectomy
BCA 31Laparoscopic unilateral adrenalectomy
BCA40 Bilateral adrenalectomy
BCA 41 Laparoscopic bilateral adrenalectomy
BCA 99 Other adrenal operations
58.Surgical technique
Laparotomy
Thoracoabdominal approach
Open retroperitoneal approach
Posterior endoscopic
Transabdominal endoscopic
Posterior robotic assisted
Transabdominal robotic assisted
59. Conversion from endoscopic to open surgery
Yes If Yes, Reason for conversion
Bleeding
Adhesions
Unclear anatomy
Difficult access
Capsular fraction
Other / No
Other op, give op code and operation in full text______
Complications
60.ICU
Yes No
61.Bleeding with transfusion
Yes No
62.Lasceration of viscus
Yes No
63.Pneumothorax
Yes No
64.Local infection abscess
Yes No
65.Re-operation
Yes If Yes, state reason for re-operation ______
No
66.Postop complications (other) ______only fill in if applicable, give ICD code
67. Treatment due to adrenal sufficiency
Yes No
68. Postop days before discharge ______
69. Deceased Yes date of death ______
No