Perioperative Management of Endocrinal Emergencies

Abstract

Endocrine emergencies are one of most important challenges in anaesthetic practice. They include:  Pituitary apoplexy: Haemorrhage or infarction of pituitary gland mostly pituitary adenomas causing suppression of hormones secretion leading to hormonal deficiencies. The immediate medical management should include careful assessment of the patient’s haemodynamic status and commencement of intravenous (IV) fluids and steroid therapy.  Thyrotoxic crisis: Acute increase in T3 and T4 in blood causing hypertention, tachydysrhythmia and fever. Management includes cooling the patient, administration of Propylthiouracil, imidazoles and β- blockers. Good preoperative preparation of the patient to be in the euthyroid state can decrease the incidence of thyroid storm. Intraoperatively, it is advised to prevent stress response to intubation, and cautiously use drugs with sympathomimetic activity.