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Anesthesia in a patient with multiple endocrine abnormalities. Case report
Renato Toledo Maciel1, Fátima Carneiro Fernandes, Leonel dos Santos Pereira
1Hospital Universitário Clementino Fraga Filho da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, RJ.
Revista Brasileira De Anestesiologia
|April 22, 2009
Summary
This case highlights a patient with insulinoma and multiple endocrine abnormalities, presenting unique anesthetic challenges. Careful intraoperative monitoring is crucial for successful insulinoma removal and managing postoperative hypoglycemia.
Area of Science:
- Endocrinology
- Surgical Oncology
- Anesthesiology
Background:
- Insulinoma, a common pancreatic endocrine tumor, can be associated with multiple endocrine neoplasia (MEN).
- This report details a patient with complex endocrine abnormalities not fitting known syndromes, necessitating tailored anesthetic management.
- The patient also presented as a Jehovah's Witness, adding a layer of complexity to surgical planning.
Observation:
- A 23-year-old female with hypoglycemia, Cushing's disease, and prolactinoma was found to have a retroperitoneal mass suspected to be insulinoma.
- Physical examination revealed obesity, protruding teeth, Mallampati 3 classification, and sleep apnea symptoms.
- Elevated hematocrit (58%) was noted, alongside a Jehovah's Witness status impacting transfusion options.
Findings:
- Anesthetic induction involved midazolam, clonidine, fentanyl, propofol, and pancuronium, with successful intubation.
- Continuous glucose monitoring and intravenous D5W infusion maintained stable intraoperative glucose levels.
- Hemodynamic stability was achieved during pneumoperitoneum, but postoperative hypoglycemia occurred, requiring re-operation.
Implications:
- This unique case underscores the importance of comprehensive preoperative assessment for patients with multiple endocrine disorders.
- Meticulous intraoperative monitoring is essential for successful insulinoma resection and preventing complications.
- Anesthesiologists must possess in-depth knowledge of interacting endocrine conditions and patient-specific factors to optimize anesthetic strategies.
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