Endocrine Surgery – Robert Bränström's research group

The endocrine and sarcoma surgery section at Karolinska treats over a thousand patients with sarcoma and tumors and/or functional disorders in endocrine organs every year, in a multidisciplinary collaboration. This makes us the largest endocrine surgery clinic in the Nordics.

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News from the Endocrine surgery group

Visting address:
Department of Molecular Medicine and Surgery
Karolinska Institutet
Karolinska University Hospital, Elite Hotel, floor 2, Solna
171 76 Stockholm

Our research

Our research is highly translational and includes epidemiological studies, quality registry-based research, molecular biology laboratory studies, and clinical treatment trials. The overall aim is to identify new targets for diagnostics, prognostic assessment, treatment, and follow-up. By leveraging large patient cohorts, we have strong opportunities to evaluate patient benefit and to identify key factors that can form the basis for continuous quality improvement.

Sarcoma

Sarcomas are rare solid tumors that can arise anywhere in the body’s soft and supportive tissues. Morphologically, they comprise more than 60 distinct histopathological subtypes. Our research focuses on sarcomas occurring in the abdomen and retroperitoneum. Within the gastrointestinal tract, gastrointestinal stromal tumor (GIST) is the dominant sarcoma subtype, with an estimated incidence of approximately 15 cases per million inhabitants per year.

GIST is believed to originate from stem cells that normally differentiate into interstitial cells of Cajal. Mutations in the KIT gene represent an early event in GIST tumorigenesis. Tyrosine kinase inhibitors, such as imatinib, effectively block KIT and often produce dramatic treatment responses, including rapid reductions in metabolic activity and tumor regression. GIST cells contain secretory granules and express multiple proteins involved in secretory mechanisms, indicating the potential for secretion of various substances. The long-term goal of our studies is to identify new targets for treatment, monitoring, and follow-up.

Thyroid

Thyroid cancer is the most common endocrine malignancy. Its incidence is increasing and now exceeds 5 per 100 000 inhabitants per year in Sweden. The overall aim of our research is to identify factors that enable individualized tumor treatment.

The most common forms of thyroid cancer - papillary and follicular - are collectively referred to as differentiated thyroid cancer. These tumors generally have a favorable prognosis; however, approximately 10% of patients die because of the disease. Our research primarily focuses on tumor development and prognostic factors.

Epidemiological studies evaluate risk factors for recurrence and disease-specific mortality, as well as effects on health-related quality of life. Molecular genetic studies include analyses at the DNA and gene expression levels, as well as proteomic investigations. Our research also encompasses other forms of thyroid cancer and the surgical treatment of functional thyroid disorders. Through large patient cohorts, we are well positioned to prospectively analyze prognostic factors and to rapidly implement research findings into clinical practice.

Parathyroid

Primary hyperparathyroidism (pHPT) is a common disease that affects women more frequently than men, with prevalence increasing with age. In population-based screening studies, pHPT has been diagnosed in 3.4% of postmenopausal women in Sweden. The condition is caused by excessive secretion of parathyroid hormone (PTH), leading to elevated blood calcium levels, and is often associated with vitamin D deficiency.

The most common cause of pHPT is a benign parathyroid adenoma. Certain malignancies are overrepresented among patients with pHPT. If left untreated, pHPT is associated with an increased long-term risk of renal insufficiency, osteoporosis, and cardiovascular disease.

Patients with pHPT often have few disease-specific symptoms, but neuropsychiatric symptoms and cognitive impairment are overrepresented, as are risk factors for cardiovascular disease and diabetes. Currently, there are no reliable methods to predict, at the individual patient level, whether these symptoms and risk factors will improve following surgery.

The aim of our research is to address existing knowledge gaps and thereby enable clear treatment indications for all patients with pHPT. Epidemiological studies are used to identify causes and risk factors. In vitro studies investigate regulatory mechanisms of PTH secretion in parathyroid adenomas and normal tissue, with the long-term goal of identifying strategies to correct dysregulated hormone secretion in pathological cells. In addition, we develop methods for parathyroid adenoma localization and surgical techniques. Using large patient cohorts, we can prospectively analyze prognostic factors and rapidly translate research findings into clinical practice.

Neuroendocrine Tumors

Neuroendocrine tumors (NET) constitute a heterogeneous group of neoplasms that can arise in several organs and are characterized by variable biological behavior, clinical presentation, and prognosis. The disease course is often prolonged, and both diagnosis and treatment frequently require multidisciplinary management.

Research in this field aims to identify prognostic factors that can be applied in quality improvement efforts to enhance diagnostics, individualize treatment and follow-up, and develop surgical techniques, with particular emphasis on ergonomics for surgeons and other healthcare staff. Epidemiological studies analyze risk factors for disease development, recurrence, and survival. Molecular genetic studies include analyses at the DNA and gene expression levels, proteomics, and investigations of drug effects on tumor cells.

Adrenal Glands

Adrenal tumors are common. The adrenal glands are responsible for the secretion of vital hormones, and both hormone excess and deficiency can have serious consequences. Hormone overproduction may be caused by tumors or functional disorders, influencing treatment strategies and follow-up.

Most adrenal tumors are benign; however, differential diagnosis is often challenging, and histopathological examination alone is not always sufficient to distinguish malignant from benign tumors. Our research focuses on the relationships between molecular, genetic, and clinical phenotypes, as well as on the significance of tumor mutations for disease risk at both the individual and familial levels.

The goal is to identify diagnostic and prognostic factors that can be utilized in diagnosis, treatment, and follow-up. In the long term, blood-based biomarkers or radiological diagnostics may help identify adrenal tumors with poorer prognoses. Our research also includes the development of advanced surgical techniques, including simulator-based training.

Contact information

If you are interested in our research, you are warmly welcome to contact the research group leader, who can guide you to the appropriate researcher within the group based on your specific interests.

Publications

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Staff and contact

Group leader

Contact persons

All members of the group