[General thoracic surgery and perioperative management in the patients with endocrine dysfunction]

Patients with perioperative endocrine dysfunction represent a particular challenge to general thoracic surgeons. This article focuses on the 3 most commonly experienced endocrine disorders:diabetes mellitus, thyroid deficiency( hyper- and hypothyroidism), and long-term steroid administration. The point is to control those endocrine disorders as best as possible before surgery to avoid severe perioperative complications. For the patients with uncontrolled endocrine disorders who are presenting for elective surgery, their surgical procedures should be postponed. Surgeons should understand the clinical condition of their patients with endocrine disorders and closely coordinate with endocrinologists and anesthesiologists for the appropriate perioperative management. Diabetes mellitus is the most common endocrinopathy in patients presenting for surgery. Surgeons should be particularly careful for their surgical technique to avoid surgical site infection and bronchopleural fistula for diabetic patients undergoing lung resection. It is advisable to normalize thyroid function in hyper- and hypothyroidism because thyroid storm and myxedema coma are severe complications and the mortality of them is high. Perioperative steroid replacement therapy is necessary for the patients taking steroids according to the magnitude of the surgical stress to avoid perioperative hemodynamic instability due to adrenal insufficiency.