Perianesthetic Management of Patients With Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas.
BACKGROUND
Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are a rare cause of secondary hyperthyroidism. Anesthetic management of these patients has not been formally described in the literature.


METHODS
Patients who underwent resection of a TSH-secreting pituitary adenoma during 1987 to 2012 at a single institution were identified. Preoperative thyroid hormone state, anesthetic management, and outcome were recorded. Hemodynamic associations with intraoperative events were compared between those who were hyperthyroid and euthyroid at the time of surgery.


RESULTS
Of 2268 patients having transsphenoidal resection of a pituitary tumor, 19 (0.84%) had resection of a TSH-secreting adenoma. At the time of surgery, 6 (32%) were hyperthyroid, 11 (58%) were euthyroid, and 2 (10%) were hypothyroid based on serum thyroxine concentration. General anesthesia was maintained with a potent inhaled anesthetic in all patients, and included nitrous oxide in 18 of 19 (95%). Seventeen (90%) had an arterial catheter placed for surgery. Only 1 patient (5%) required an intraoperative blood transfusion. There were no significant differences in heart rate or blood pressure at induction of anesthesia, upon intranasal injection of local anesthetic containing epinephrine, or upon emergence from anesthesia, between patients who were chemically hyperthyroid or euthyroid. Twelve of 19 (63%) had tumor extension beyond the sella turcica. Common complications were nausea and vomiting (42%), diabetes insipidus (32%), and temporary or permanent hypopituitarism (42%).


CONCLUSIONS
Patients having resection of TSH-secreting pituitary adenomas can present in any thyroid state. An awareness of risks and potential complications in patients with TSH-secreting adenomas can help tailor perioperative care.
*Mayo Clinic School of Health Sciences Departments of †Anesthesiology §Neurosurgery ‡Mayo Clinic College of Medicine, Rochester, MN.
Matthew W
MW
Dyer
Amy
A
Gnagey
Bryan T
BT
Jones
Roger D
RD
Pula
William L
WL
Lanier
John L D
JLD
Atkinson
Jeffrey J
JJ
Pasternak
D000236:Adenoma / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019990:Perioperative Care; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D013100:Sphenoid Bone / Q000601:surgery*; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000378:metabolism*; D016896:Treatment Outcome
D013963:Thyroid Hormones; D013972:Thyrotropin