Management of Patient with Pituitary Tumor (Cushing’s Disease)
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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.
KeywordsTranssphenoidal surgery Pituitary tumor Cushing’s disease Acromegaly Glucocorticoids Hypothalamic–pituitary–adrenal axis Cerebrospinal fluid leak Diabetes insipidus
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