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Kirbas G, Ozkalkanli MY, Tuzen AS. The effect of preoperative TSH levels on perioperative complications in patients undergoing pituitary surgery. Eur J Med Res 2024; 29:259. [PMID: 38689357 PMCID: PMC11059711 DOI: 10.1186/s40001-024-01860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Pituitary surgery involves special conditions for the anaesthetist due to the anatomical localisation and the role of the pituitary gland in hormonal balance. The aim of this study was to retrospectively investigate the effect of TSH levels on perioperative complication rates in patients undergoing pituitary surgery. METHODS In this study, patients who underwent pituitary surgery at Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2017 and November 2022 were retrospectively screened. Two patients out of the 137 were excluded from the study as they underwent simultaneous aneurysm surgery along with pituitary tumor surgery. A total of 135 patients meeting the criteria were analyzed. Patients were divided into three groups according to TSH levels. Perioperative complication rates and mortality rates were compared between the three groups. FINDINGS The study included a total of 135 patients, with an age range of 16-76 years. Among the groups with low-normal-high TSH levels, there were no statistically significant difference observed, in postoperative complications, such as epistaxis, rhinorrhea, postoperative nausea/vomiting, seizures, hypertension, and hypotension. When looking at the incidence of postoperative diabetes insipidus, a significant difference was found between the groups. When examining the mortality rates on the 28th day, a significant difference was found between the groups, with a mortality rate of 25% in the high TSH group (p < 0.5). CONCLUSIONS The risk of perioperative mortality is higher in patients with TSH levels above normal.
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Affiliation(s)
- Gizem Kirbas
- Anesthesiology and Reanimation Department, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Murat Yasar Ozkalkanli
- Anesthesiology and Reanimation Department, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ahmet Salih Tuzen
- Anesthesiology and Reanimation Department, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Malhotra B, Bhadada SK. Perioperative Management for Non-Thyroidal Surgery in Thyroid Dysfunction. Indian J Endocrinol Metab 2022; 26:428-434. [PMID: 36618525 PMCID: PMC9815191 DOI: 10.4103/ijem.ijem_273_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
Thyroid hormone exerts effects across all organ systems. Hence, patients with thyroid dysfunction are at a risk of numerous complications. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation, and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to optimize the status of thyrotoxic and hypothyroid patients. This article describes the adverse effects of thyroid dysfunction in patients undergoing nonthyroid surgery and recommends treatment approaches aimed at appropriate build-up to decrease perioperative risk.
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Spada F, Rossi RE, Kara E, Laffi A, Massironi S, Rubino M, Grimaldi F, Bhoori S, Fazio N. Carcinoid Syndrome and Hyperinsulinemic Hypoglycemia Associated with Neuroendocrine Neoplasms: A Critical Review on Clinical and Pharmacological Management. Pharmaceuticals (Basel) 2021; 14:ph14060539. [PMID: 34199977 PMCID: PMC8228616 DOI: 10.3390/ph14060539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 02/05/2023] Open
Abstract
The carcinoid syndrome (CS) and hyperinsulinemic hypoglycemia (HH) represent two of the most common clinical syndromes associated with neuroendocrine neoplasms (NENs). The former is mainly related to the serotonin secretion by a small bowel NEN, whereas the latter depends on an insulin hypersecretion by a pancreatic insulinoma. Both syndromes/conditions can affect prognosis and quality of life of patients with NENs. They are often diagnosed late when patients become strongly symptomatic. Therefore, their early detection and management are a critical step in the clinical management of NEN patients. A dedicated and experienced multidisciplinary team with appropriate therapeutic strategies is needed and should be encouraged to optimize clinical outcomes. This review aims to critically analyze clinical features, evidence and treatment options of CS and HH and therefore to improve their management.
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Affiliation(s)
- Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, via G. Ripamonti 435, 20141 Milano, Italy; (F.S.); (A.L.); (M.R.)
| | - Roberta E. Rossi
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS, Istituto Nazionale Tumori (INT), via G. Venezian 1, 20133 Milano, Italy; (R.E.R.); (S.B.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, via Festa del Perdono 7, 20122 Milano, Italy
| | - Elda Kara
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy; (E.K.); (F.G.)
| | - Alice Laffi
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, via G. Ripamonti 435, 20141 Milano, Italy; (F.S.); (A.L.); (M.R.)
| | - Sara Massironi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano Bicocca, 20126 Milano, Italy;
| | - Manila Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, via G. Ripamonti 435, 20141 Milano, Italy; (F.S.); (A.L.); (M.R.)
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy; (E.K.); (F.G.)
| | - Sherrie Bhoori
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS, Istituto Nazionale Tumori (INT), via G. Venezian 1, 20133 Milano, Italy; (R.E.R.); (S.B.)
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, via G. Ripamonti 435, 20141 Milano, Italy; (F.S.); (A.L.); (M.R.)
- Correspondence: ; Tel.: +39-025-748-9258
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The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020). JOURNAL OF PANCREATOLOGY 2021. [DOI: 10.1097/jp9.0000000000000064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Himes CP, Ganesh R, Wight EC, Simha V, Liebow M. Perioperative Evaluation and Management of Endocrine Disorders. Mayo Clin Proc 2020; 95:2760-2774. [PMID: 33168157 DOI: 10.1016/j.mayocp.2020.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 12/25/2022]
Abstract
Evaluation of endocrine issues is a sometimes overlooked yet important component of the preoperative medical evaluation. Patients with diabetes, thyroid disease, and hypothalamic-pituitary-adrenal axis suppression are commonly encountered in the surgical setting and require unique consideration to optimize perioperative risk. For patients with diabetes, perioperative glycemic control has the strongest association with postsurgical outcomes. The preoperative evaluation should include recommendations for adjustment of insulin and noninsulin diabetic medications before surgery. Recommendations differ based on the type of diabetes, the type of insulin, and the patient's predisposition to hyperglycemia or hypoglycemia. Generally, patients with thyroid dysfunction can safely undergo operations unless they have untreated hyperthyroidism or severe hypothyroidism. Patients with known primary or secondary adrenal insufficiency require supplemental glucocorticoids to prevent adrenal crisis in the perioperative setting. Evidence supporting the use of high-dose supplemental corticosteroids for patients undergoing long-term glucocorticoid therapy is sparse. We discuss an approach to these patients based on the dose and duration of ongoing or recent corticosteroid therapy. As with other components of the preoperative medical evaluation, the primary objective is identification and assessment of the severity of endocrine issues before surgery so that the surgeons, anesthesiologists, and internal medicine professionals can optimize management accordingly.
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Affiliation(s)
- Carina P Himes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Vinaya Simha
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Mark Liebow
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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6
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Jain D, Khan Joad AS. Head and neck radiotherapy - A risk factor for anaesthesia? Indian J Anaesth 2020; 64:488-494. [PMID: 32792713 PMCID: PMC7398013 DOI: 10.4103/ija.ija_864_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/24/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim was to study perioperative management in head and neck cancer, the commonest cancer in Indian men, after radiation therapy. Radiotherapy (RT) targets the tumour and the neck including the thyroid gland. RT induced physical effects (on the airway) and physiological effects (on the thyroid) impact perioperative care. Patients with RT-induced subclinical and mild clinical hypothyroidism are often asymptomatic. Cancer surgery is time-sensitive. Given that parenteral levothyroxine is not available, is a TSH of 15 acceptable for cancer surgery? METHODS A retrospective study was conducted in a tertiary cancer centre. The records of elective surgery (72 patients) were scrutinised. Data on thyroid profile, airway, treatment of clinical and subclinical hypothyroidism, airway access, recovery and perioperative haemodynamic parameters were retrieved. Correlation of age, sex, RT, chemotherapy with hypothyroidism was done by Chi-square test. The perioperative course was studied. RESULTS Hypothyroidism (subclinical and clinical) was diagnosed in 39% of patients. All were asymptomatic. There was a significant association between RT and hypothyroidism. In 50% of patients, we encountered a difficult airway. In subclinical hypothyroidism (TSH less than 15), after levothyroxine initiation, the course of anaesthesia, extubation, recovery and postoperative stay was uneventful. CONCLUSIONS Hypothyroidism and difficult airways are a common sequel of RT. Selected cancer patients with subclinical hypothyroidism had a smooth perioperative course.
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Affiliation(s)
- Deepshikha Jain
- Department of Anaesthesia and Palliative Care, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Anjum S Khan Joad
- Department of Anaesthesia and Palliative Care, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
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Vacante M, Biondi A, Basile F, Ciuni R, Luca S, Di Saverio S, Buscemi C, Vicari ESD, Borzì AM. Hypothyroidism as a Predictor of Surgical Outcomes in the Elderly. Front Endocrinol (Lausanne) 2019; 10:258. [PMID: 31068905 PMCID: PMC6491643 DOI: 10.3389/fendo.2019.00258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/04/2019] [Indexed: 12/30/2022] Open
Abstract
There is a high prevalence of hypothyroidism in the elderly population, mainly among women. The most important cause is autoimmune thyroiditis, but also iodine deficiency, radioiodine ablation, and surgery may be responsible for hypothyroidism in elderly hospitalized patients. Thyroid-related symptoms are sometimes comparable to physiological manifestations of the aging process, and hypothyroidism may be related with many symptoms which can be present in critical patients, such as cognitive impairment, cardiovascular, gastrointestinal, and hematological alterations, and eventually myxedema coma which is a severe and life-threatening condition in older adults. Adequate thyroid hormone levels are required to achieve optimal outcomes from any kind of surgical intervention. However, only few randomized clinical trials investigated the association between non-thyroidal illness (or low-T3 syndrome), and adverse surgical outcomes, so far. The goal of this review is to discuss the role of thyroid function as a predictor of surgical outcomes in the elderly.
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Affiliation(s)
- Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Roberto Ciuni
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Luca
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carola Buscemi
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy
| | - Enzo Saretto Dante Vicari
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy
| | - Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy
- *Correspondence: Antonio Maria Borzì
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Aissa I, Benakrout A, Meziane M, Bensghir M, Lalaoui SJ. [Asystole during surgery to manage small intestine cancer: are we dealing with anaphylaxis or carcinoid crisis]. Pan Afr Med J 2018; 30:92. [PMID: 30344876 PMCID: PMC6191273 DOI: 10.11604/pamj.2018.30.92.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/10/2018] [Indexed: 11/11/2022] Open
Abstract
Cardiac arrest in the operating room is a life-threatening event with multiple causes. We report the case of a 53-year old female patient with no particular past medical history scheduled for surgery to manage small intestine cancer. Twenty minutes after anesthetic induction the patient had asystole rapidly reversible after resuscitation measures. The association of face rash with chest rash gave rise to suspicion of late anaphylactic reaction. Rapid patient recovery allowed to resume surgical procedure. Tumor manipulation immediately caused a second severe bradycardia rapidly reversible after the administration of 0.5 mg atropine. Skin rush at the level of the face and the chest occurred again. This second complication immediately gave rise to suspicion of carcinoid crisis. Sandostatine was then administered. No other complication occurred, the patient spent 24 hours in the Intensive Care Unit receiving sandostatine infusion. Urinary 5-HIAA values were very high and histological examination of the surgical specimen confirmed carcinoid tumor. This study aims to highlight the rarity of this entity and the importance of suspecting carcinoid crisis in patients with intraoperative complications during anesthesia for small intestine tumor surgery.
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Affiliation(s)
- Ismail Aissa
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Aziz Benakrout
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mohamed Meziane
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mustapha Bensghir
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Salim Jaafar Lalaoui
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
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Oronsky B, Ma PC, Morgensztern D, Carter CA. Nothing But NET: A Review of Neuroendocrine Tumors and Carcinomas. Neoplasia 2017; 19:991-1002. [PMID: 29091800 PMCID: PMC5678742 DOI: 10.1016/j.neo.2017.09.002] [Citation(s) in RCA: 399] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
This review covers the diverse topic of neuroendocrine neoplasms (NENs), a relatively rare and heterogeneous tumor type, comprising ~2% of all malignancies, with a prevalence of <200,000 in the United States, which makes it an orphan disease (Basu et al., 2010).1 For functional purposes, NENs are divided into two groups on the basis of clinical behavior, histology, and proliferation rate: well differentiated (low grade to intermediate grade) neuroendocrine tumors and poorly differentiated (high grade) neuroendocrine carcinoma (Bosman et al., 2010)2; this histological categorization/dichotomization is highly clinically relevant with respect to impact on treatment and prognosis even though it is not absolute since a subset of tumors with a low-grade appearance behaves similarly to high-grade lesions. Given the relative dearth of evidenced-based literature about this orphan disease as a whole (Modlin et al., 2008),3 since the focus of most articles is on particular anatomic subtypes of NENs (i.e., gastroenteropancreatic or pulmonary), the purpose of this review is to summarize the presentation, pathophysiology, staging, current standard of care treatments, and active areas of current research.
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Affiliation(s)
- Bryan Oronsky
- EpicentRx Inc, 4445 Eastgate Mall, Suite 200, San Diego, CA 92121, USA.
| | - Patrick C Ma
- West Virginia University, Mary Babb Randolph Cancer Center, 8901 Wisconsin Ave., PO Box 9162, Morgantown, WV 26506, USA
| | - Daniel Morgensztern
- Washington University School of Medicine, Division of Oncology, 660 S. Euclid, Box 8056, St. Louis, MO 63110, USA
| | - Corey A Carter
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
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Kaltsas G, Caplin M, Davies P, Ferone D, Garcia-Carbonero R, Grozinsky-Glasberg S, Hörsch D, Tiensuu Janson E, Kianmanesh R, Kos-Kudla B, Pavel M, Rinke A, Falconi M, de Herder WW. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors. Neuroendocrinology 2017; 105:245-254. [PMID: 28253514 PMCID: PMC5637287 DOI: 10.1159/000461583] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/10/2017] [Indexed: 01/25/2023]
Abstract
Neuroendocrine tumors of the small intestine are the most common causes of the carcinoid syndrome. Carcinoid heart disease occurs in more than half of the patients with the carcinoid syndrome. Patients with carcinoid heart disease who need to undergo surgery should also undergo preoperative evaluation by an expert cardiologist. Treatment with long-acting somatostatin analogs aims at controlling the excessive hormonal output and symptoms related to the carcinoid syndrome and at preventing a carcinoid crisis during interventions. Patients with a gastrinoma require pre- and postoperative treatment with high doses of proton pump inhibitors. Patients with a glucagonoma require somatostatin analog treatment and nutritional supplementation. Patients with a VIPoma also require somatostatin analog treatment and intravenous fluid and electrolyte therapy. Insulinoma patients generally require intravenous glucose infusion prior to operation. In patients with localized operable insulinoma, somatostatin analog infusion should only be considered after the effect of this therapy has been electively studied.
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Affiliation(s)
- Gregory Kaltsas
- Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
- *Gregory Kaltsas, Sector of Endocrinology, Department of Pathophysiology, National and Kapodistrian University of Athens, Mikras Assias 75, Goudi, GR-11527 Athens (Greece), E-Mail
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | | | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research (CEBR), IRCCS AOU San Martino-IST, University of Genova, Genova, Italy
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Unit, Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dieter Hörsch
- Gastroenterology and Endocrinology Center for Neuroendocrine Tumors Bad Berka, Bad Berka, Germany
| | - Eva Tiensuu Janson
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Reza Kianmanesh
- Department of Digestive and Endocrine Surgery, Robert Debré Hospital, Reims, France
| | - Beata Kos-Kudla
- Department of Pathophysiology and Endocrinology, Division of Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marianne Pavel
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin
| | - Anja Rinke
- Department of Gastroenterology, UKGM Marburg and Philipps University Marburg, Marburg, Germany
| | - Massimo Falconi
- Chirurgia del Pancreas, Pancreas Translational and Clinical Research Center, Ospedale San Raffaele, Università “Vita e Salute”, Milano, Italy
| | - Wouter W. de Herder
- ENETS Centre of Excellence, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
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Weickert MO. Should malnutrition screening be routine for patients with GEP-NET? INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije-2016-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Martin O Weickert
- The ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry & Warwickshire NHS Trust, CV2 2DX, Coventry, UK
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12
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Sarıtaş A, Sarıtaş PU, Kurnaz MM, Çelik A. Spectrum and Prevalence of Thyroid Disorders in Patients Admitted to the Anaesthesiology Outpatient Clinic for Surgery. Turk J Anaesthesiol Reanim 2016; 43:240-5. [PMID: 27366505 DOI: 10.5152/tjar.2015.03206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE An anaesthetic approach and surgery are important treatment strategies in patients with thyroid dysfunction due to potential complications. We investigated the prevalence of thyroid disorders, the significance of thyroid function tests (TFTs) with respect to anaesthesia in the preoperative period and the need for routine examinations. METHODS A total of 10,600 patients who were admitted to the anaesthesiology outpatient clinic for surgery were retrospectively screened and enrolled between 2011 and 2013. Evident hypothyroidism was defined as free tetra-iodothyronine (fT4) <0.7 ng dL(-1) and thyroid-stimulating hormone (TSH) >4 mIU mL(-1), and subclinical hypothyroidism was defined as TSH >4 mIU mL(-1) with normal free hormone levels. Evident hyperthyroidism was defined as fT4 >1.7 ng dL(-1) and TSH <0.1 mIU mL(-1), and subclinical hyperthyroidism was defined as TSH <0.1 mIU mL(-1) with normal free hormone levels. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 17.0. Independent samples t-test and one-way analysis of variance were used to compare the difference between groups. RESULTS Of the participants, 8.5% were found to have hypothyroidism, 2.5% had hyperthyroidism, 3.5% received treatment and 2.5% had their treatment postponed. The likelihood of hypothyroidism was greater among females, and no difference was found between genders with respect to hyperthyroidism. CONCLUSION We believe that TFTs are important because of regional factors. However, given the high cost of TFTs and because thyroid dysfunction risk increases with age, we concluded that routine TFTs in young patients with normal physical examination findings are not mandatory.
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Affiliation(s)
- Aykut Sarıtaş
- Department of Anaestesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Pelin Uzun Sarıtaş
- Department of Anaestesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Muhammed Murat Kurnaz
- Department of Anaestesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Abdullah Çelik
- Department of Cardiothoracic Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
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Abstract
BACKGROUND Demographic change has also caused changes in perioperative intensive care because the proportion of geriatric patients who must undergo surgical procedures is increasing. With the current preoperative assessment instruments, it is still not possible to identify high-risk patients of this collective or to make a reliable prognosis concerning postoperative course. MATERIALS AND METHODS In addition to pain control, important aspects to minimize complications in postoperative intensive care include adequate oxygenation, adequate fluid management, an adequate supply of energy and nutrients, good control of blood sugar levels, and early mobilization of patients. RESULTS The perioperative intensive care treatment of geriatric patients requires the readiness to engage in interdisciplinary collaboration because only with this close dialog can the treatment results be sustained.
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Abstract
Carcinoid tumours pose a great challenge to anaesthesiologist, especially if carcinoid syndrome is present. We report peri-operative management of a patient with carcinoid syndrome who underwent upper lobectomy. Pre-operative optimisation for 10 days before surgery with injection octreotide and administration on the day of surgery as per guidelines was followed (North American Neuroendocrine Tumour Society guidelines). Our main goals were to prevent mediator release, avoidance of triggering factors and management of peri-operative carcinoid crisis. During tumour handling patient developed carcinoid crisis which was effectively treated with intravenous bolus octreotide and increasing rate of infusion.
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Affiliation(s)
- Prasoon Gupta
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Ranvinder Kaur
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Lalita Chaudhary
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Aruna Jain
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
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Hodin R, Lubitz C, Phitayakorn R, Stephen A. Diagnosis and management of pheochromocytoma. Curr Probl Surg 2014; 51:151-87. [DOI: 10.1067/j.cpsurg.2013.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
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Lynggård LA, Nielsen EH, Laurberg P. Carcinoid syndrome caused by a serotonin-secreting pituitary tumour. Eur J Endocrinol 2014; 170:K5-9. [PMID: 24174286 DOI: 10.1530/eje-13-0622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neuroendocrine tumours are most frequently located in the gastrointestinal organ system or in the lungs, but they may occasionally be found in other organs. CASE We describe a 56-year-old woman suffering from a carcinoid syndrome caused by a large serotonin-secreting pituitary tumour. She had suffered for years from episodes of palpitations, dyspnoea and flushing. Cardiac disease had been suspected, which delayed the diagnosis, until blood tests revealed elevated serotonin and chromogranin A in plasma. The somatostatin receptor (SSR) scintigraphy showed a single-positive focus in the region of the pituitary gland and MRI showed a corresponding intra- and suprasellar heterogeneous mass. After pre-treatment with octreotide leading to symptomatic improvement, the patient underwent trans-cranial surgery with removal of the tumour. This led to a clinical improvement and to a normalisation of SSR scintigraphy, as well as serotonin and chromogranin A levels. CONCLUSION To our knowledge, this is the first reported case of a serotonin-secreting tumour with a primary location in the pituitary.
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Affiliation(s)
- Louise A Lynggård
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
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Kang YM, Kim YH. Anesthetic experiences of myxoma removal surgery in two patients with Carney complex -A report of two cases-. Korean J Anesthesiol 2012; 61:528-32. [PMID: 22220234 PMCID: PMC3249579 DOI: 10.4097/kjae.2011.61.6.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 11/10/2022] Open
Abstract
Carney complex is an autosomal dominant disorder that occurs due to a mutation in PRKAR1A, which encodes protein kinase A. The clinical features are multiple endocrine gland neoplasms, skin tumors, pigmented skin lesions, myxomas, and schwannomas. In Carney complex, the cardiac myxoma is a common co-morbidity. It occurs in multiples, during young age, regardless of gender and cardiac chamber and is known to recur frequently. Therefore there are high risks of adhesion and massive bleeding due to repeated surgeries. Such surgical risks account for over 50% of disease-specific mortality of Carney complex patients. Here, we present anesthetic experiences of myxoma removal surgery in two patients with Carney complex.
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Affiliation(s)
- Young Mi Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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Mancuso K, Kaye AD, Boudreaux JP, Fox CJ, Lang P, Kalarickal PL, Gomez S, Primeaux PJ. Carcinoid syndrome and perioperative anesthetic considerations. J Clin Anesth 2011; 23:329-41. [PMID: 21663822 DOI: 10.1016/j.jclinane.2010.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 12/07/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
Carcinoid tumors are uncommon, slow-growing neoplasms. These tumors are capable of secreting numerous bioactive substances, which results in significant potential challenges in the management of patients afflicted with carcinoid syndrome. Over the past two decades, both surgical and medical therapeutic options have broadened, resulting in improved outcomes. The pathophysiology, clinical signs and symptoms, diagnosis, treatment options, and perioperative management, including anesthetic considerations, of carcinoid syndrome are presented.
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Affiliation(s)
- Kenneth Mancuso
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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Levin MA, Flynn BC. Case report: primary ovarian carcinoid: a rare tumor causing unexpected manifestations in a previously undiagnosed woman. Anesth Analg 2011; 112:1158-60. [PMID: 21372282 DOI: 10.1213/ane.0b013e318214292f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although carcinoid tumors arising from midgut structures are rare, the existence of these tumors is well documented. However, carcinoid tumors arising from the reproductive organs, such as primary ovarian carcinoids, are rare and sparsely documented. Because of this rarity, a small percentage of women may present with ovarian masses that are not properly diagnosed as carcinoid tumor creating unexpected hemodynamic changes under general anesthesia. However, prior knowledge of the clinical manifestations of this rare entity may improve the sensitivity of the preoperative evaluation and allow the anesthesiologist to take precautions as a result of the suspicion of ovarian carcinoid.
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Affiliation(s)
- Matthew A Levin
- Department of Anesthesiology, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl., Box 1010, New York, NY 10029, USA
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20
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Joseph S, Wang YZ, Boudreaux JP, Anthony LB, Campeau R, Raines D, O'Dorisio T, Go VL, Vinik AI, Cundiff J, Woltering EA. Neuroendocrine tumors: current recommendations for diagnosis and surgical management. Endocrinol Metab Clin North Am 2011; 40:205-31, x. [PMID: 21349420 DOI: 10.1016/j.ecl.2010.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neuroendocrine tumors (NETs) are rare neoplasms found in diverse locations within the body. These tumors are commonly classified by the primary tumor's location, further subclassified by their differentiation, and finally segregated by their ability to hypersecrete peptides or amines. A number of groups have summarized their recommendations for diagnosis and therapy; however, the rarity of these lesions makes prospective randomized multiinstitutional trials difficult. Thus, these "consensus statements" often remain opinion-based. The authors have collaboratively developed a consensus on the current diagnostic work-up necessary for patients with NETs to help clinicians with this confusing field and followed this with some of the more advanced surgical techniques and considerations that are currently only available in specialty centers to show the evolving management of NETs.
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Affiliation(s)
- Saju Joseph
- Section of Endocrine Surgery, Department of Surgery, Louisiana State University Health Sciences Center, 200 West Esplanade Avenue, Suite 200, Kenner, LA 70065, USA
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Stefan M, Iglesia Lino L, Fernandez G. Medical consultation and best practices for preoperative evaluation of elderly patients. Hosp Pract (1995) 2011; 39:41-51. [PMID: 21441758 DOI: 10.3810/hp.2011.02.373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Preoperative evaluation of elderly patients is an important component of surgical practice in the 21st century. It can offer a comprehensive geriatric evaluation and be a key element in decreasing postoperative morbidity and mortality in this unique population group. Advanced surgical and anesthetic techniques have contributed to an increasing number of elderly and sicker geriatric patients undergoing surgery. Elderly patients have limited physiologic reserve and pose many challenges in the perioperative setting, and a careful preoperative risk assessment aimed toward minimizing operative risks is essential. Advanced age increases the risk of developing complications post-surgery, but comorbidities are more important than age alone. General recommendations include avoiding drugs that increase the risk of delirium, ensuring appropriate hydration and calorie intake, minimizing bed rest, promoting ambulation, and early planning for discharge. Collaboration between surgeons and medical consultants aids in the identification of functional, cognitive, and nutritional deficits, provides structure for development and implementation of management plans, and promotes optimal patient outcome after surgical intervention in the elderly.
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Affiliation(s)
- Mihaela Stefan
- Department of Internal Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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Abdulazim A, Citak M, Backhaus M, Stienen MN, Horch C. Primary carcinoid tumor of the filum terminale--a case report. Acta Neurochir (Wien) 2010; 152:1975-9. [PMID: 20676702 DOI: 10.1007/s00701-010-0756-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 07/20/2010] [Indexed: 10/19/2022]
Abstract
Carcinoid tumors with a primary site in the central nervous system have not been reported in literature yet. We report here about a 41-year-old patient with recurrent and progressive low back pain and bilateral S1 radiculopathy on admission. The patient underwent hemi-laminectomies of the vertebral bodies L5 and S1 and an en bloc resection of the tumor. Postoperative histopathological examination resulted in a well-differentiated intrathecal neuroendocrine tumor (carcinoid) of the terminal filum. Postoperative staging showed no pathological abnormalities and no tumor recurrence after 6 months. Even though rare, carcinoids should be considered as differential diagnosis of tumors occurring in the CNS.
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Abstract
This article reviews current knowledge concerning the monitoring of endocrine function in patients in the clinical setting. Monitoring techniques are discussed and literature is reviewed regarding diabetes mellitus, thyroid, and parathyroid disorders, pheochromocytoma, adrenal insufficiency, and carcinoid tumors.
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Affiliation(s)
- Vivek Moitra
- Division of Critical Care, Department of Anesthesiology, PH 527-B, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Anaesthetic management of a pregnant woman with carcinoid disease. Int J Obstet Anesth 2009; 18:272-5. [DOI: 10.1016/j.ijoa.2009.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/15/2008] [Accepted: 01/14/2009] [Indexed: 11/18/2022]
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Abstract
Pheochromocytomas are rare neuroendocrine tumors with a highly variable clinical presentation, but they most commonly present as spells of headaches, sweating, palpitations, and hypertension. Patients with pheochromocytoma may develop complicated and potentially lethal cardiovascular and other complications, especially in the setting of diagnostic or interventional procedures (e.g. upon induction of anesthesia or during surgery). The serious and potentially lethal nature of such complications is due to the potent effect of paroxysmal release of catecholamines. Because this warrants prompt diagnosis and treatment, the physician should be aware of the clinical manifestations and complications of catecholamine excess and be able to provide proper preoperative management to minimize catecholamine-related pre-, intra-, and postoperative adverse events. The following clinical scenario and discussion aim to enhance the knowledge of the physician regarding the behavior of pheochromocytoma and to outline current approaches to comprehensive preoperative management of patients suffering from this tumor.
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Affiliation(s)
- Karel Pacak
- Section on Medical Neuroendocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, Maryland 20892-1109, USA.
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Arora VM, McGory ML, Fung CH. Quality Indicators for Hospitalization and Surgery in Vulnerable Elders. J Am Geriatr Soc 2007; 55 Suppl 2:S347-58. [PMID: 17910557 DOI: 10.1111/j.1532-5415.2007.01342.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Abstract
PURPOSE OF REVIEW Carcinoid tumors secrete many different types of substances (e.g. serotonin, bradykinin) that may produce potentially fatal intraoperative reactions such as hypotension and bronchoconstriction. The most effective treatment for the deleterious cardiovascular and pulmonary effects of serotonin and bradykinin is octreotide, a somatostatin analogue. Carcinoid heart disease, which develops in the majority of patients with carcinoid syndrome, presents the anesthesiologist with more diagnostic and therapeutic dilemmas. RECENT FINDINGS The incidence of carcinoid tumors is much greater than previously recognized. New diagnostic techniques permit identification and localization of carcinoid tumors with greater accuracy. Short term and long term therapy with octreotide significantly improves survival and reduces the severity of 'carcinoid crises'. Echocardiographic studies have demonstrated a very high incidence of carcinoid heart disease (tricuspid and pulmonary insufficiency) in patients with carcinoid syndrome. Cardiac valve surgery is, consequently, becoming much more common in patients with carcinoid syndrome. SUMMARY More patients with carcinoid tumors and carcinoid syndrome are requiring anesthesia and surgery. Specific therapy with somatostatin analogues (octreotide) has replaced older less specific drugs (e.g. antihistamines) for the treatment of adverse effects caused by products of carcinoid tumors.
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Affiliation(s)
- Stephen F Dierdorf
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Abstract
PURPOSE OF REVIEW Diabetes mellitus has diverse effects on all organ systems of the body. Insulin physiology and metabolic control are far more complex than previously thought. Research continues to reveal more information about the central role of insulin in metabolism. The treatment of hypertension and nephropathy as well as hyperglycemia in patients with diabetes has emerged as being critical for prevention of long-term diabetic complications. The issue of primary importance to the anesthesiologist is whether strict glycemic and hemodynamic control during the perioperative period affect outcome. RECENT FINDINGS Maintenance of euglycemia and physiologic control of insulin responses to changes in glucose levels have been shown to prolong life and reduce complications from diabetes mellitus. The identification and treatment of prediabetic patients may significantly delay the onset of overt diabetes. Perioperative control of glucose has become tighter, but the optimum level of glucose and ideal method of insulin delivery during surgery remain controversial. Perioperative control of blood pressure and vascular responses may be as important as glucose control for prevention of adverse perioperative events. SUMMARY Tight long-term control of glucose and blood pressure improve outcome in patients with diabetes. The same philosophy of management is being applied to the perioperative period. Routine measurement of intraoperative blood glucose levels and appropriate insulin administration are now standard practice, but the ideal regimen for insulin administration remains to be determined.
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Affiliation(s)
- Stephen F Dierdorf
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Suzuki K, Awata S, Oyama Y, Fujiyama M, Takano T, Sugawara A, Matsuoka H. Agitated depression successfully treated with electroconvulsive therapy combined with steroid cover in a patient with Addison's disease. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:956-8. [PMID: 17324493 DOI: 10.1016/j.pnpbp.2007.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 01/12/2007] [Accepted: 01/14/2007] [Indexed: 12/01/2022]
Abstract
We report the case of a 70-year-old man with Addison's disease who developed severe agitated depression resulting in life-threatening medical conditions. The depression was treated safely with electroconvulsive therapy (ECT) combined with steroid cover. Administration of steroid cover just before each ECT session may increase safety of the ECT procedure in psychiatric patients with Addison's disease.
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Affiliation(s)
- Kazumasa Suzuki
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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Hudcova J, Schumann R. Undiagnosed catecholamine-secreting paraganglioma and coexisting carcinoid in a patient with MH susceptibility: an unusual anesthetic challenge. J Anesth 2007; 21:80-2. [PMID: 17285421 DOI: 10.1007/s00540-006-0462-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 09/30/2006] [Indexed: 10/23/2022]
Abstract
The management of a patient with two undiagnosed neuroendocrine tumors and possible malignant hyperthermia (MH) susceptibility poses a unique challenge to the anesthesiologist. We describe a total intravenous anesthetic including an alpha 2-agonist infusion combined with epidurally administered bupivacaine for intra- and postoperative pain management. Alpha 2-agonists may offer improved intraoperative hemodynamic management in patients with catecholamine-secreting tumors and reduce the total dose needed for intravenous anesthetics such as propofol. The latter mechanism may be useful to avert the risk of the propofol infusion syndrome occurring as a consequence of a high cumulative dose following its prolonged administration.
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Affiliation(s)
- Jana Hudcova
- Department of Anesthesia, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW The multiple endocrine neoplasia (MEN) syndromes present a diverse array of challenges to the anesthesiologist. The tumors and their effects are often underdiagnosed and potentially discovered only when the patient is undergoing surgery for either a component of one of the syndromes or another procedure altogether. This can present the anesthesiologist with a life-threatening situation in the operating room. A thorough understanding of the syndromes, as well as management strategies, will enable the anesthesiologist to handle these patients. RECENT FINDINGS Advances in the pharmacologic armamentarium available to physicians have enabled patients with MEN, particularly those with the carcinoid syndrome or pheochromocytoma, to undergo surgery safely, with minimal morbidity and mortality. SUMMARY Awareness of the components of the MEN syndromes, as well as careful preoperative preparation, paves the way for a smooth anesthetic and postoperative course in these patients.
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Affiliation(s)
- Florence Grant
- Memorial Hospital, Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, 1275 York Avenue, New York, NY 10021, USA.
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Bernene J, Zgonis T, Jolly GP. Diabetes mellitus and pharmacological therapy. Clin Podiatr Med Surg 2003; 20:635-53. [PMID: 14636030 DOI: 10.1016/s0891-8422(03)00066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Diabetes mellitus can be a devastating lifelong disease if not treated appropriately. The physician and the patient should be aware of both extremes involved with DM: hyperglycemia and hypoglycemia. Patient education and preventive care are perhaps more important in this disease than many others. A multidisciplinary approach involving the patient, physician, and diabetic educator is best to assure a better quality of life. Enormous advances in the treatment of diabetes have occurred over the past decade and even greater ones can be expected in the future. New drugs, insulin delivery devices, and noninvasive glucose monitoring machines have the potential to normalize blood sugar levels and return diabetics to a near normal lifespan without complications.
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Affiliation(s)
- James Bernene
- Department of Medicine, New Britain General Hospital, New Britain, CT 06052, USA
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