Acromegaly

 

Pituitary hormones:

Anterior

·      ACTH

·      TSH

·      GH

·      FSH and LH

·      PRL

Posterior

·      ADH

·      Oxytocin

 

The M’s:

Mass

·      Risk of pituitary insufficiency

·      Need test ± replacement

·      Especially glucocorticoid, thyroid hormones

Metastases

·      N/A

Metabolic

·      Growth hormone -> see below

Medication

·      Somatostatin

·      Bromocriptine -> postural hypotension

 

Acromegaly issues:

Airway

·      Enlarged and distorted soft tissues

·      Narrowed subglottis

->Difficult bag-mask ventilation. Need large mask and OPA.

->Difficult intubation. Need VL with large blades but smaller ETT.

Breathing

·      OSA

->Awake extubation

->Care with opioids

Cardiovascular

·      HTN

·      Ischaemic heart disease

·      Cardiomyopathy

->Need arterial line

->Need CVS stability

Endocrine

·      T2DM

·      Pituitary dysfunction

·      Central diabetes insipidus -> desmopressin

->Need regular ABG intra-op

->Need regular bloods post-op

Musculoskeletal

·      Enlarged and distorted skeleton (e.g. kyphosis)

->Care with patient positioning

·      Neurovascular compression syndromes (e.g. ulnar artery in 50%)

->Avoid radial arterial line

 

Surgery issues:

Airway

·      Remote

·      Shared

·      Difficulty

->Must secure properly

Microsurgery

·      Requires immobility

·      Rx remifentanil infusion + atracurium infusion

 

Conflicts:

Post-op CPAP

·      Benefit (OSA)

·      Harm (pneumocephalus)

Analgesia

·      Benefit (relieve suffering)

·      Harm (OSA)

 

 

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