Abstract
A 68-year-old female patient with previous history of transsphenoidal hypophysectomy operation underwent three-vessel coronary artery bypass graft (CABG) surgery for extensive coronary artery disease. Preoperative neurological examination revealed sequelae visual loss at right temporal visual field. Follow-up Magnetic Resonance Imaging studies showed a residual hypophyseal tumor tissue extending to suprasellar area. No additional pathology was detected in the early postoperative cranial control CT, but aggravation of visual field defect was determined. Coincidently, cranial magnetic resonance imaging (MRI) showed hemorrhage into the tumor tissue. We decided to follow-up the patient who exhibited no additional symptoms and was discharged well on the fifth day due to the signs of resolution of hemorrhage. Follow-up controls of the patient at sixth and twelfth months demonstrated normal hormone levels without any additional clinical complaints. We present preoperative assessment, perioperative anesthesia management, and postoperative clinical follow-up of a patient with a residual hypophyseal tumor.
Highlights
Hypophyseal macroadenoma incidence is reported to be 30/100.000 [1]
Perioperative anesthesia management, and postoperative clinical follow-up of a patient with a residual hypophyseal tumor
Hypopituitarism developing after coronary bypass surgery, is a known phenomenon of rare occurrence [4].One of the favorite pathophysiological mechanisms is the fall of arterial blood pressure induces ischemia and that is followed by infarction of the pituitary gland [5]
Summary
Radiotherapy, mechanical ventilation, and cardiac bypass surgery (CBP), these tumors may have sudden infarction and hemorrhage [2]. In these complicated cases, the clinical management is sometimes difficult. Pituitary apoplexy occurs spontaneously in 60% - 80% cases of asymptomatic patients. Common predisposing factors are head trauma, hypotension, hypertension, pituitary irradiation history, cardiac surgery, anticoagulant therapy treatment with dopamine agonists, pituitary stimulation tests and pregnancy [1,3]. Hypopituitarism developing after coronary bypass surgery, is a known phenomenon of rare occurrence [4].One of the favorite pathophysiological mechanisms is the fall of arterial blood pressure induces ischemia and that is followed by infarction of the pituitary gland [5]. The ratio of men to women is 10 to 1 in favor of men [1]
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