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Pituitary apoplexy occurring during large volume liposuction surgery
Amir Cohen1, Kamal Kishore, Leo Wolansky
1UMDNJ-Robert Wood Johnson Medical School, Newark, NJ 07103-2441, USA.
Summary
A rare case of pituitary apoplexy occurred in a woman after liposuction. Intraoperative hypotension during the surgery likely triggered bleeding in an undiagnosed pituitary adenoma.
Area of Science:
- Endocrinology
- Neurosurgery
- Anesthesiology
Background:
- Pituitary apoplexy is a clinical syndrome characterized by sudden onset of severe headache, visual impairment, and ophthalmoplegia, usually due to hemorrhage or infarction of a pituitary adenoma.
- Liposuction is a common cosmetic surgical procedure with potential complications, including hemodynamic instability.
Observation:
- A 50-year-old woman experienced headache and right-sided ophthalmoplegia post-liposuction under general anesthesia.
- Neuroimaging revealed hemorrhage in a previously unrecognized pituitary adenoma.
- Surgical specimen confirmed pituitary apoplexy with infarction and hemorrhage.
Findings:
- Intraoperative records showed a 30-minute period of systolic blood pressure at 90 mm Hg from a baseline of 120 mm Hg.
- The hypotension was attributed to general anesthesia, lidocaine, plasma sequestration, and blood loss.
- This is the first reported case of pituitary apoplexy associated with liposuction surgery.
Implications:
- This case highlights the risk of pituitary apoplexy in patients with undiagnosed pituitary adenomas undergoing procedures associated with significant hemodynamic stress.
- Anesthesiologists and surgeons should be vigilant for potential pituitary apoplexy in patients undergoing liposuction, especially if hypotension occurs.
- Further research is needed to elucidate the precise mechanisms and risk factors for pituitary apoplexy in this context.