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CASE REPORT
Year : 2015  |  Volume : 59  |  Issue : 3  |  Page : 182-185

Anaesthetic concerns during adrenalectomy for Cushing's syndrome with known hyperhomocysteinemia


1 Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India
2 Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India

Correspondence Address:
Nirmala Jonnavithula
Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.153041

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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.


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