Skip to main content
SpringerLink
Log in

Neuroanesthesia and Coexisting Endocrine Problems

  • Chapter
  • First Online:
Co-existing Diseases and Neuroanesthesia

Abstract

Patients who present for neurosurgery often have coexisting endocrine problems that may lead to serious perioperative complications. Many of these endocrine dysfunctions are the result of underlying neurological condition or surgical insult and, therefore, signify a poor outcome. Poor management of perioperative endocrine dysfunction might also exacerbate the underlying brain injury. It is, therefore, imperative to identify and manage neurosurgical patients with endocrine dysfunction. In this chapter, we reviewed the five most commonly encountered coexisting endocrine problems in contemporary neuroanesthetic practice. These include (1) anterior pituitary dysfunction, (2) diabetes insipidus, (3) approach to neurosurgical hyponatremia, (4) perioperative glycemic control, and (5) perioperative steroid replacement.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Garrahy A, Sherlock M, Thompson CJ. Management of endocrine disease: neuroendocrine surveillance and management of neurosurgical patients. Eur J Endocrinol. 2017;176(5):R217–33.

    Article  CAS  Google Scholar 

  2. Beshyah SA, Freemantle C, Thomas E, Rutherford O, Page B, Murphy M, et al. Abnormal body composition and reduced bone mass in growth hormone deficient hypopituitary adults. Clin Endocrinol. 1995;42(2):179–89.

    Article  CAS  Google Scholar 

  3. Cuneo RC, Salomon F, Wiles CM, Hesp R, Sonksen PH. Growth hormone treatment in growth hormone-deficient adults. II. Effects on exercise performance. J Appl Physiol. 1991;70(2):695–700.

    Article  CAS  Google Scholar 

  4. Cittadini A, Cuocolo A, Merola B, Fazio S, Sabatini D, Nicolai E, et al. Impaired cardiac performance in GH-deficient adults and its improvement after GH replacement. Am J Physiol. 1994;267:E219–25.

    CAS  PubMed  Google Scholar 

  5. Hannon MJ, Crowley RK, Behan LA, O’Sullivan EP, O’Brien MMC, Sherlock M, et al. Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality. J Clin Endocrinol Metab. 2013;98(8):3229–37.

    Article  CAS  Google Scholar 

  6. Can A, Gross BA, Smith TR, Dammers R, Dirven CMF, Woodmansee WW, et al. Pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurgery. 2016;79(2):253–64.

    Article  Google Scholar 

  7. Robba C, Bacigaluppi S, Bragazzi N, Lavinio A, Gurnell M, Bilotta F, et al. Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis. Pituitary. 2016;19(5):522–35.

    Article  CAS  Google Scholar 

  8. Crompton MR. Hypothalamic lesions following the rupture of cerebral berry aneurysms. Brain. 1963;86:301–14.

    Article  CAS  Google Scholar 

  9. Daniel PM, Rrichard MM, Treip CS. Traumatic infarction of the anterior lobe of the pituitary gland. Lancet. 1959;2(7109):927–31.

    Article  CAS  Google Scholar 

  10. Powell J, Kitchen N, Heslin J, Greenwood R. Psychosocial outcomes at 18 months after good neurological recovery from aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2004;75(8):1119–24.

    Article  CAS  Google Scholar 

  11. Hütter BO, Kreitschmann-Andermahr I, Gilsbach JM. Cognitive deficits in the acute stage after subarachnoid hemorrhage. Neurosurgery. 1998;43(5):1054–65.

    Article  Google Scholar 

  12. Hütter BO, Gilsbach JM, Kreitschmann I. Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg. 1995;9(4):465–75.

    Article  Google Scholar 

  13. Smith M, Hirsch NP. Pituitary disease and anaesthesia. Br J Anaesth. 2000;85(1):3–14.

    Article  CAS  Google Scholar 

  14. Pyrgelis E-S, Mavridis I, Meliou M. Presenting symptoms of pituitary apoplexy. J Neurol Surg. 2018;79(1):52–9.

    Article  Google Scholar 

  15. Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6):1937–49.

    Article  CAS  Google Scholar 

  16. Hannon MJ, Behan LA, O’Brien MMC, Tormey W, Ball SG, Javadpur M, et al. Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting. J Clin Endocrinol Metab. 2014;99(1):291–8.

    Article  CAS  Google Scholar 

  17. Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2009;103(3):448–54.

    Article  Google Scholar 

  18. Agha A, Thornton E, O’Kelly P, Tormey W, Phillips J, Thompson CJ. Posterior pituitary dysfunction after traumatic brain injury. J Clin Endocrinol Metab. 2004;89(12):5987–92.

    Article  CAS  Google Scholar 

  19. Hannon MJ, Finucane FM, Sherlock M, Agha A, Thompson CJ. Disorders of water homeostasis in neurosurgical patients. J Clin Endocrinol Metab. 2012;97(5):1423–33.

    Article  CAS  Google Scholar 

  20. Cuesta M, Hannon MJ, Thompson CJ. Adipsic diabetes insipidus in adult patients. Pituitary. 2017;20(3):372–80.

    Article  Google Scholar 

  21. Sherlock M, Agha A, Crowley R, Smith D, Thompson CJ. Adipsic diabetes insipidus following pituitary surgery for a macroprolactinoma. Pituitary. 2006;9(1):59–64.

    Article  CAS  Google Scholar 

  22. Sigounas DG, Sharpless JL, Cheng DML, Johnson TG, Senior BA, Ewend MG. Predictors and incidence of central diabetes insipidus after endoscopic pituitary surgery. Neurosurgery. 2008;62(1):71–9.

    Article  Google Scholar 

  23. Tan J, Ndoro S, Okafo U, Garrahy A, Agha A, Rawluk D. Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms. N Z Med J. 2016;129(1447):86–90.

    PubMed  Google Scholar 

  24. Seckl J, Dunger D. Postoperative diabetes insipidus. BMJ. 1989;298(6665):2–3.

    Article  CAS  Google Scholar 

  25. Thompson CJ, Selby P, Baylis PH. Reproducibility of osmotic and nonosmotic tests of vasopressin secretion in men. Am J Physiol. 1991;260(3):R533–9.

    CAS  PubMed  Google Scholar 

  26. Fraser JF, Stieg PE. Hyponatremia in the neurosurgical patient: epidemiology, pathophysiology, diagnosis, and management. Neurosurgery. 2006;59(2):222–9.

    Article  Google Scholar 

  27. Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med. 2009;122(9):857–65.

    Article  CAS  Google Scholar 

  28. Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care. 2008;12(6):R162.

    Article  Google Scholar 

  29. Sherlock M, O’Sullivan E, Agha A, Behan LA, Rawluk D, Brennan P, et al. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol. 2006;64(3):250–4.

    Article  Google Scholar 

  30. Sherlock M, O’Sullivan E, Agha A, Behan LA, Owens D, Finucane F, et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J. 2009;85(1002):171–5.

    Article  CAS  Google Scholar 

  31. Peters JP, Welt L, Sims E, Orloff J, Needham J. A salt wasting syndrome associated with cerebral disease. Trans Assoc Am Phys. 1950;63:57–64.

    CAS  PubMed  Google Scholar 

  32. Agha A, Rogers B, Mylotte D, Taleb F, Tormey W, Phillips J, et al. Neuroendocrine dysfunction in the acute phase of traumatic brain injury. Clin Endocrinol. 2004;60(5):584–91.

    Article  CAS  Google Scholar 

  33. Gullans SR, Verbalis JG. Control of brain volume during hyperosmolar and hypoosmolar conditions. Annu Rev Med. 1993;44(1):289–301.

    Article  CAS  Google Scholar 

  34. Griesdale DEG, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821–7.

    Article  Google Scholar 

  35. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1–42.

    Article  Google Scholar 

  36. Hays RM. Vasopressin antagonists--progress and promise. N Engl J Med. 2006;355(20):2146–8.

    Article  CAS  Google Scholar 

  37. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.

    Article  Google Scholar 

  38. Green DM, O’Phelan KH, Bassin SL, Chang CWJ, Stern TS, Asai SM. Intensive versus conventional insulin therapy in critically ill neurologic patients. Neurocrit Care. 2010;13(3):299–306.

    Article  CAS  Google Scholar 

  39. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY-S, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  Google Scholar 

  40. Liu-DeRyke X, Collingridge DS, Orme J, Roller D, Zurasky J, Rhoney DH. Clinical impact of early hyperglycemia during acute phase of traumatic brain injury. Neurocrit Care. 2009;11(2):151–7.

    Article  Google Scholar 

  41. McGirt MJ, Woodworth GF, Ali M, Than KD, Tamargo RJ, Clatterbuck RE. Persistent perioperative hyperglycemia as an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2007;107(6):1080–5.

    Article  CAS  Google Scholar 

  42. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Goldenberg R, Punthakee Z. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes. 2013;37:S8–S11.

    Article  Google Scholar 

  43. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Supplement 1):S81–90.

    Article  Google Scholar 

  44. Kushner M, Nencini P, Reivich M, Rango M, Jamieson D, Fazekas F, et al. Relation of hyperglycemia early in ischemic brain infarction to cerebral anatomy, metabolism, and clinical outcome. Ann Neurol. 1990;28(2):129–35.

    Article  CAS  Google Scholar 

  45. Vespa P, Boonyaputthikul R, McArthur DL, Miller C, Etchepare M, Bergsneider M, et al. Intensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury. Crit Care Med. 2006;34(3):850–6.

    Article  CAS  Google Scholar 

  46. Baron AD, Brechtel G, Wallace P, Edelman SV. Rates and tissue sites of non-insulin- and insulin-mediated glucose uptake in humans. Am J Physiol. 1988;255(6):E769–74.

    CAS  PubMed  Google Scholar 

  47. Mizock BA. Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med. 1995;98(1):75–84.

    Article  CAS  Google Scholar 

  48. Myers RE, Yamaguchi S. Nervous system effects of cardiac arrest in monkeys. Preservation of vision. Arch Neurol. 1977;34(2):65–74.

    Article  CAS  Google Scholar 

  49. Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg. 1991;75(4):545–51.

    Article  CAS  Google Scholar 

  50. Siesjö BK, Ingvar M, Pelligrino D. Regional differences in vascular autoregulation in the rat brain in severe insulin-induced hypoglycemia. J Cereb Blood Flow Metab. 1983;3(4):478–85.

    Article  Google Scholar 

  51. Hollinger BR, Bryan RM. Beta-receptor-mediated increase in cerebral blood flow during hypoglycemia. Am J Physiol. 1987;253(4 Pt 2):H949–55.

    CAS  PubMed  Google Scholar 

  52. Boyle PJ, Schwartz NS, Shah SD, Clutter WE, Cryer PE. Plasma glucose concentrations at the onset of hypoglycemic symptoms in patients with poorly controlled diabetes and in nondiabetics. N Engl J Med. 1988;318(23):1487–92.

    Article  CAS  Google Scholar 

  53. Auer RN. Progress review: hypoglycemic brain damage. Stroke. 1986;17(4):699–708.

    Article  CAS  Google Scholar 

  54. Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300(8):933–44.

    Article  CAS  Google Scholar 

  55. Bilotta F, Caramia R, Paoloni FP, Delfini R, Rosa G. Safety and efficacy of intensive insulin therapy in critical neurosurgical patients. Anesthesiology. 2009;110(3):611–9.

    Article  CAS  Google Scholar 

  56. NICE-SUGAR Study Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, Finfer S, Chittock D, Li Y, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study. Intensive Care Med. 2015;41(6):1037–47.

    Article  Google Scholar 

  57. Thiele RH, Pouratian N, Zuo Z, Scalzo DC, Dobbs HA, Dumont AS, et al. Strict glucose control does not affect mortality after aneurysmal subarachnoid hemorrhage. Anesthesiology. 2009;110(3):603–10.

    Article  Google Scholar 

  58. Dhatariya K, Levy N, Flanagan D, Hilton L, Kilvert A, Rayman G, et al. Management of adults with diabetes undergoing surgery and elective procedures: improving standards, summary [Internet]. Joint British Diabetes Societies. 2015 [cited 2017 Dec 28]. pp. 1–48. Available from: https://www.diabetes.org.uk

  59. Bell BA, Smith MA, Kean DM, McGhee CN, MacDonald HL, Miller JD, et al. Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone. Lancet. 1987;1(8524):66–9.

    Article  CAS  Google Scholar 

  60. Ryken TC, McDermott M, Robinson PD, Ammirati M, Andrews DW, Asher AL, et al. The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96(1):103–14.

    Article  CAS  Google Scholar 

  61. Vecht CJ, Hovestadt A, Verbiest HB, van Vliet JJ, van Putten WL. Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology. 1994;44(4):675–80.

    Article  CAS  Google Scholar 

  62. Lewis L, Robinson RF, Yee J, Hacker LA, Eisen G. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med. 1953;39(1):116–26.

    Article  CAS  Google Scholar 

  63. Brown CJ, Buie WD. Perioperative stress dose steroids: do they make a difference? J Am Coll Surg. 2001;193(6):678–86.

    Article  CAS  Google Scholar 

  64. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, Husebye ES, Merke DP, Murad MH, Stratakis CA, Torpy DJ. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:364–89.

    Article  CAS  Google Scholar 

  65. Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative steroid management: approaches based on current evidence. Anesthesiology. 2017;127(1):166–72.

    Article  Google Scholar 

  66. Axelrod L. Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin N Am. 2003;32(2):367–83.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia & Perioperative Medicine, London Health Science Centre, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Jason Chui

  2. Department of Anaesthesia and Intensive Care, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong

    Matthew T. V. Chan

Authors
  1. Jason Chui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew T. V. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew T. V. Chan .

Editor information

Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Department of Neuroanesthesiology and Neurocritical Care, Medanta, The Medicity, Gurugram, India

    Vasudha Singhal

  3. Department of Neuroanaesthesia, Indraprastha Apollo Hospital, New Delhi, India

    Nidhi Gupta

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chui, J., Chan, M.T.V. (2019). Neuroanesthesia and Coexisting Endocrine Problems. In: Prabhakar, H., Singhal, V., Gupta, N. (eds) Co-existing Diseases and Neuroanesthesia. Springer, Singapore. https://doi.org/10.1007/978-981-13-2086-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-2086-6_6

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2085-9

  • Online ISBN: 978-981-13-2086-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation