Hypothalamic Injury as a Cause of Refractory Hypotension after Sellar Region Tumor Surgery

Abstract

Hypothalamic damage can result in life-threatening vasodilatory arterial hypotension after sellar region tumor surgery. beta-Sympatomimetics are indicated in cases with thyroid insufficiency.

Intra-abdominal hypertension in patients with sellar region tumors

“…However, the cause-and-effect relationship between IAP and severity of the patients' condition remains unclear. Severe injury to the hypothalamo-pituitary axis can lead to MOD [4]. On the other hand, our patients had high maximal IAP values, and IAH can also be considered as a cause of MOD [5,12].…”

“…The clinical picture in SRT patients is typically a combination of altered level of consciousness, water and electrolyte disturbances (fluid balance dysregulation with hyper- or hyponatremia in the absence of iatrogenic causes, such as inadequate use of desmopressin, vaptans (V 2 -receptor antagonists), or hyperosmotic solutions), and at least one new organ dysfunction/failure as defined by a sequential organ failure assessment [SOFA] subscore equal to or above 3 [4]. This entity has been defined previously as diencephalon dysfunction [DD].…”

“…Routine CT imaging of the brain was performed immediately postsurgery. Most patients were ventilated, and crystalloids or colloids and sympathomimetics were started early when indicated and to maintain perfusion pressure [4]. …”

“…Abdominal compartment syndrome [ACS] leads to multiple organ dysfunction [MOD] and carries a high mortality [4,5]. Ileus is considered as a contributing factor leading to IAH [1].…”

“…Ileus is considered as a contributing factor leading to IAH [1]. Patients with recent removal of sellar region tumors [SRT] represent a special neurocritical care population because they have an increased risk of postoperative ileus [4]. …”