Anesthesia for Untreated Hypothyroidism

Kim, Jong Min; Hackman, Larry

doi:10.1213/00000539-197703000-00030

Cited by 23 publications

(10 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fortunately, emergence from anaesthesia was uneventful in our patient. Low basal metabolic rate and an inability to increase core temperature when challenged by cold makes maintaining normothermia under anaesthesia difficult, as we experienced [19, 20]. Hyponatraemia and hypovolaemia due to impaired renal function may create an unpredictable and often prolonged response to many of the anaesthetic agents [21].…”

Section: Discussionmentioning

confidence: 99%

Intra‐operative diagnosis of hypopituitarism in a patient undergoing radical nephrectomy

Pillai

Spears

2005

Anaesthesia

View full text Add to dashboard Cite

A 43-year-old woman presented for elective radical nephrectomy. After induction of anaesthesia, she developed hypotension that failed to respond to standard treatment measures. Her core temperature decreased to 34°C in spite of active warming. She required very low concentrations of anaesthetic agents to maintain an adequate depth of anaesthesia for abdominal surgery. After excluding the common causes of hypotension, the possibility of subclinical hypopituitarism was considered and subsequently confirmed. The clinical manifestations of acquired partial or complete hypopituitarism will depend on the type and degree of hormone deficiency and the rapidity of its onset [1]. It is only when a patient is under the stress of illness or surgery that partial corticotrophin deficiency may produce the clinical symptoms of adrenal insufficiency [2]. With the exception of growth hormone, which is deficient in most patients with hypopituitarism, it is impossible to predict which pituitary hormones will be deficient in a particular patient [1]. We report a case of undiagnosed hypopituitarism and describe its manifestations, the manner in which it was diagnosed intra-operatively, and its subsequent treatment. Case reportA 43-year-old Congolese woman was referred to a consultant haematologist with generalised aches, poor appetite and weight loss. Initial investigations revealed hypochromic, microcytic anaemia, a low white cell count and hyponatraemia in the presence of a normal serum potassium level. She was found to be HIV and sickle negative. She gave a history of being treated for tuberculosis as a child. Her only medication was iron supplementation. An abdominal mass was palpable on examination, and an ultrasound showed a mass in the upper pole of right kidney. The patient was referred for a urological opinion. A computerised tomography scan showed a well-circumscribed renal tumour of 7.5 cm diameter without evidence of local, lymphatic or distant metastatic spread. Radical nephrectomy was planned. Sequential blood tests confirmed anaemia (haemoglobin concentration ¼ 9.2 g.dl ) and hyponatraemia (serum sodium ¼ 128 mmol.l )1 ) but with a normal coagulation profile and normal serum potassium, urea and creatinine levels. The patient was seen by an anaesthetist on the day before surgery. She had undergone uneventful general anaesthetics in the past. Her pre-operative blood pressure was 96 ⁄ 60 mmHg; her heart rate was 66 beat.min )1 ; her S p O 2 was 97% on room air; she weighed 43 kg; her body temperature was 35.5°C. After the insertion of a thoracic epidural, she was pre-oxygenated and anaesthesia was induced with remifentanil 100 lg and propofol slowly titrated to a total of 160 mg. Neuromuscular blockade was achieved with atracurium 30 mg. After induction, her blood pressure decreased to 70 ⁄ 40 mmHg and her heart rate to 56 beat.min )1. Intravenous ephedrine was given in 6-mg boluses to a total of 30 mg, but this failed to produce an increase in heart rate or blood pressure. After tracheal intubation, anaesthesia was maint...

show abstract

Section: Discussionmentioning

confidence: 99%

Intra‐operative diagnosis of hypopituitarism in a patient undergoing radical nephrectomy

Pillai

Spears

2005

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…These include hypoventilation resulting from a decreased ventilatory response to arterial hypoxaemia and hypercapnoea,5 depressed basal metabolic rate, leading to increased susceptibility to perioperative hypothermia; and hypotension, (a consequence of bradycardia, reduced cardiac output and attentuated baroreceptor reflexes).' In combination these render the myxoedematous patient particularly sensitive to the depressant action of many drugs, including opiates, 6 intravenous induction agents and anaesthetic vapours. 8…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia in a Patient with Untreated Myxoedema Coma

Cone

1994

Anaesth Intensive Care

View full text Add to dashboard Cite

“…Patients with mitochondrial disease are sensitive to anesthesia[ 3 ] and hypoglycemic coma can be the presenting sign in Addison's disease. [ 4 ] However, we did not think these were possible etiologies based on medical history of our patient.…”

mentioning

confidence: 82%