Anesthetic Management of a Child with Adrenocortical Virilizing Tumour Excision

Abstract

Introduction: A multidisciplinary team that includes an endocrinologist, radiologist, anesthesiologist, and surgeon is a prerequisite for adrenal gland surgeries. The prime indications for adrenal gland surgery can include both hormonal and non-hormonal secreting tumors. Adrenal hormone-secreting tumors usually present to the anesthesiologist with a unique set of challenges that require a good preoperative evaluation and hemodynamic control, corrections of all electrolytes and metabolic imbalances, a carefully planned anesthetic strategy, detailed knowledge about the specific diseases, maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will mainly focus on endocrine issues and anesthetic management during the resection of a hormone-secreting adrenal gland tumor. Case Presentation: This is a case report of a 1.5-year-old boy weighing 13.5 kg who was admitted to our hospital with complaints of an increase in height and weight more than appropriate for age, macroglossia, facial oedema, abnormally enlarged genitals and development of pubic hair for 6 months. On examination along with signs of precocious puberty, he had presented raised blood pressure for which he was started on medication. Results: On ultrasonography, a 6*4 cm mass was seen in the right supra renal fossa which was confirmed on the CECT scan. He underwent surgery for the excision of the tumor mass under general anesthesia with a regional blockade (epidural). The histopathological report of the tumor specimen revealed Adrenocortical Carcinoma. The child required post-operative steroid treatment and subsequently was started on chemotherapy as well. Conclusion: The perioperative medical management of active Adreno Cortical Carcinomas is complex enough, but anesthesia causes even more substantial changes in physiology. Treatment with steroids helps to maintain hemodynamics to a great extent.