• Anaesthesia and pituitary disease
    • Symptoms
      • Hormone hypersecretion
      • Hormone hyposecretion
      • Mass effect
        • Headache
        • Field defects
        • CN palsies
        • Hydrocephalus
        • Raised ICP
    • Hypersecretion
      Syndromes
      • Acromegaly
        • Excess in GH usually from functioning pituitary macroadenoma (>10mm)
        • Present with symptoms of mass effect and excess GH
        • BMV usually easy
        • Laryngoscopy more difficult due to macrognathia, large tongue, expansion of upper airway tissues
        • OSAS is common
        • Proximal myopathy and kyphoisis can be seen
        • HT, LVH, cor pulmonale, IHD, arrhythmias, heart block, cardiomyopathy also seen
        • Positioning is vital due to nerve entrapment
        • DM may be present
      • Cushing's disease
        • Due to ACTH hypersecretion
        • Truncal obesity, moon facies, proximal myopathy, thin skin, osteoporosis, exopthalmos, buffalo hump, OSAS, HT, LVH, VTE, DM, PUD all features
      • Prolactinomas
        • Hyperprolactinaemia causes galactorrhoea, menstrual disturbances, hypogonadism, reduced libido, erectile dysfunction
        • Surgery only if bromocriptine/cabergoline fail
    • Hyposecretion
      Syndromes
      • Adrenocortical insufficiency
        • Rx saline, dextrose and IV hydrocortisone
      • Hypothyroidism
        • IV T3
      • DI
        • DDAVP
    • General aims
      • Haemodynamic stability
      • Intubation
        • Consider AFOI
        • Pack for secretions
      • IV or inhalational agents suitable
      • Intense stimulus with fracture of the nasal septum
      • Lumbar drains may be inserted prior to surgery to allow injection of saline to promote descent of the tumour. Controlled hypercapnoea can achieve the same result
      • VAE is uncommon as is carotid artery injury
      • Nurse in HDU post-op
        • Test VA and visual fields regularly
        • DI usually develops in the first 24 hrs
      • All require steroid replacement
      • Liase with endocrinologists
    • Surgery
      • Mostly transphenoidal
        • Benefits
          • Avoids craniotomy
          • Less blood loss
          • Direct access to the gland
        • Complications
          • CSF leak
          • Meningitis
          • Panhypopituitarism
          • Transient DI
          • Vascular damage
          • CN injury
          • Cerebral ischaemia, stroke
        • Use of cocaine as a vasoconstrictor can lead to exaggerated hypertensive response
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/11/4/133.full.pdf