Preoperative and postoperative management of pituitary adenoma in a child
Marjana Burmuzoska, Filip Naumovski, Biljana Kuzmanovska, Andrijan Kartalov
University Clinic of anesthesiology, reanimation and intensive care - Skopje
Giriş:
Pituitary adenomas and craniopharyngiomas are the most frequent tumors in the suprasellar area, giving a similar symptomatology and because of their benign characteristics they have good prognosis if they are suitably managed. These tumors give compressive symptoms and also hormonal dysfunctions that must be noted and treated in multidisciplinary manner before and after surgery.
Olgu: A 14 years old male patient was admitted for suprasellar mass surgery, complaining with progressive symptomatology of visual impairment and headaches. Preoperative MRI scan was done, showing suprasellar oval and cystic formation with dimensions 2*3cm and compression of nearby structures. Also lab analysis revealed slightly lower serum sodium (135mmol/L) and low cortisol (27.6nmol/L), testosterone (<20ng/dl), TSH (0.206 IU/ml) with T3 and T4 levels. Transcranial surgical removal was performed under general anesthesia maintained with Remifentanil (240-560μg/h) and Sevoflurane (1.5 vol%). During the surgery patient was hemodinamicaly stable without significant blood loss. He was extubated in the OR, but maintained in ICU for 24h. Endocrinologist was consulted for treatment of the hormonal dysbalance and treatment with Hydrocortisone and Levothyroxine was initiated. Further electrolyte impairment or polyuria weren’t noted. According to the histological finding the tumor was mixed adenoma. The child recovered in 8days and was discharged in stable condition.
Tartışma ve Sonuç: Pituitary surgery is quite complex and the aim is to restore the normal pituitary secretion and eliminate the mass effect and visual impairment. Many aspects should be covered: to avoid neuronal damage of the surrounding structures, to avoid bleeding by maintaining hypotensive anesthesia, timely to treat hormonal dysbalance and to recognize diabetes insipidus which can be a frequent condition in the first 24h after surgery.
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