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Management of Patient with Pituitary Tumor (Cushing’s Disease)

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Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care

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Abstract

Transsphenoidal surgery (TSS) is performed in removal of the majority of pituitary tumors, although transcranial surgery may be needed in the case of a large pituitary tumor with no or a minor intrasellar component present. Careful review of preoperative imaging studies, endocrinological profiles, neurological deficits, and systemic involvements secondary to abnormal hormone secretion is essential. It is important to understand the anatomical boundaries encountered during TSS, especially those nerves and vasculatures at risk of injury. The main goals of intraoperative anesthetic management are to maintain hemodynamic stability and cerebral perfusion, facilitate surgical exposure, and ensure a prompt emergence for neurological examination. It is critical to avoid any maneuvers that might add positive pressure to nasopharyngeal airway for the risk of cerebrospinal fluid leak and subsequent meningitis postoperatively. Diabetes insipidus may occur in PACU and warrants prompt workup and treatment.

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Suggested Reading

  • Dunn LK, Nemergut EC. Anesthesia for transsphenoidal pituitary surgery. Curr Opin Anaesthesiol. 2013;26(5):549–54.

    Article  CAS  Google Scholar 

  • Lonser RR, Nieman L, Oldfield EH. Cushing’s disease: pathobiology, diagnosis, and management. J Neurosurg. 2017;126(2):404–17.

    Article  Google Scholar 

  • Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Chapter 63. Neurosurgical anesthesia. In: Miller’s anesthesia; 2010. p. 2074.

    Google Scholar 

  • Nemergut EC, Dumont AS, Barry UT, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg. 2005;101(4):1170–81.

    Article  Google Scholar 

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Authors and Affiliations

  1. General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA

    Hui Yang

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  1. Hui Yang
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Correspondence to Hui Yang .

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Editors and Affiliations

  1. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Hemanshu Prabhakar

  2. Vice chair for education & Associate Director of Neuroanesthesiology, Allegheny Health Network, Pittsburgh, PA, USA

    Shobana Rajan

  3. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Indu Kapoor

  4. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Charu Mahajan

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Yang, H. (2020). Management of Patient with Pituitary Tumor (Cushing’s Disease). In: Prabhakar, H., Rajan, S., Kapoor, I., Mahajan, C. (eds) Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-0458-7_15

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  • DOI: https://doi.org/10.1007/978-981-15-0458-7_15

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  • Publisher Name: Springer, Singapore

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  • Online ISBN: 978-981-15-0458-7

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