The referral pattern of endocrine problems and neck lumps is variable, so general surgery trainees are likely to see these conditions during their training. Most endocrine problems are found in the thyroid or parathyroid glands, but the adrenal and endocrine pancreas can also be affected. The examination is generally directed towards the specific endocrine system, but any endocrine gland mass may be associated with an endocrine syndrome, producing widespread effects on the patient. As with the history and examination, investigations are targeted towards the endocrine gland in question, in order to firm up the diagnosis. Biochemical assays are available to determine the levels of most hormones in the serum as a measure of disease. Provocation tests involve administering an agent that stimulates production of the hormone in question. Genetic tests are used mainly to screen first- and second-degree relatives of patients with multiple endocrine neoplasia (MEN) syndrome. Most patients complain of a painless cystic lump.