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[Coronary artery bypass surgery in a patient with hypopituitarism]
T Yasuda1, M Kawasuji, N Sakakibara
1Department of Surgery (I), Kanazawa University, School of Medicine, Japan.
Insights
Patients with hypopituitarism undergoing coronary artery bypass grafting can avoid perioperative complications with careful hormone replacement. This case study shows safe surgery and symptom relief with perioperative cortisol and thyroid hormone administration.
Area of Science:
- Cardiology
- Endocrinology
Background:
- Patients with hypopituitarism face increased risks of perioperative complications, particularly adrenal insufficiency and hypothyroidism.
- Coronary artery bypass grafting (CABG) presents unique challenges for patients with endocrine disorders.
Observation:
- A 53-year-old woman with postinfarction unstable angina and hypopituitarism underwent CABG.
- The patient received intravenous hydrocortisone preoperatively and for two weeks postoperatively, followed by oral administration.
- Perioperative thyroxine therapy was administered to prevent myocardial ischemia.
Findings:
- The patient experienced no perioperative complications during or after the CABG procedure.
- Postoperative hormone replacement therapy, including cortisol and thyroid hormone, effectively maintained normal adrenal and thyroid function.
- Optimal thyroid hormone levels were achieved post-surgery.
Implications:
- This case demonstrates the safety and feasibility of CABG in hypopituitary patients with appropriate hormone management.
- Effective perioperative endocrine management is crucial for preventing complications in patients with hypopituitarism undergoing major surgery.
- The patient remained angina-free post-surgery, highlighting the benefits of comprehensive hormone replacement therapy.
Abstract:
Patients with hypopituitarism are prone to perioperative complications resulting from adrenal insufficiency or hypothyroidism. Coronary artery bypass grafting was performed safely in a 53-year-old woman with postinfarction unstable angina and hypopituitarism. Cortisol and thyroid hormone were administered to maintain normal adrenal and thyroid function during and after the operation. Hydrocortisone was administered intravenously the day before surgery and for 2 weeks postoperatively and then was administered orally. Perioperative replacement thyroxine therapy was administered to avoid acute myocardial ischemia. Optimal thyroid replacement was achieved after surgery. No perioperative complications were seen. The patient remains free of angina with postoperative cortisol and thyroid hormone replacement therapy.