title: Anaesthetic concerns during adrenalectomy for Cushing's syndrome with known hyperhomocysteinemia.
abstract: Maintenance of homeostasis during anaesthesia in the patient with two major metabolic disorders whose systemic effects either compliment or contradict each other is a challenge to the anaesthesiologist. A 25-year-old male patient with Cushing's syndrome and known hyperhomocysteinemia was scheduled for open adrenalectomy. Both these disorders compound the hypercoagulable state and differ in glucose metabolism. In addition, obesity, difficult airway, electrolyte and metabolic derangements that accompany Cushing's syndrome warrant special attention. He was on anticoagulant therapy and inferior vena cava filter following an episode of pulmonary thromboembolism with deep vein thrombosis. Perioperative hydrocortisone was administered. Thoracic epidural catheter was placed at T10-T11 interspace, standard general anaesthesia was administered without nitrous oxide. Patient was extubated following an uneventful procedure and discharged home on 10(th) post-operative day. Understanding the anaesthetic implications and the pathophysiological interactions of multiple metabolic disorders with a potential for multisystem involvement is key to the successful management of these patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Jonnavithula
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Praveen Reddy
authors.initials: PR
authors.lastname: Elmati
authors.affiliation: Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Duddu
authors.affiliation: Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Pvln
authors.initials: P
authors.lastname: Murthy
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Gopinath
authors.initials: G
authors.lastname: Ramachandran
keywords: Anticoagulants; Cushing's syndrome; hyperhomocysteinemia; pulmonary embolism
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