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KEY POINTS

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KEY POINTS

  1. Endocrine disorders, in particular diabetes mellitus (DM), are common in the surgical population. Patients with DM type 1 are insulin deficient and require exogenous insulin at all times to prevent the life-threatening complication of diabetic ketoacidosis. DM type 2, which is much more common, may be treated in single-agent therapy with oral agents, insulin, or noninsulin injectable drugs. Combination therapy is frequent. Anticipating that fasting and the stress of surgery will make perioperative blood sugar levels erratic allows the anesthesiologist to control blood sugars within a targeted range.

  2. Acute and chronic complications of DM, including neuropathy, nephropathy, and cardiovascular disease, increase perioperative risks of complications such as infection, poor wound healing, and hemodynamic instability.

  3. Thyroid disorders, including hypothyroidism, hyperthyroidism, and thyroid nodules, are commonly encountered. Patients with uncontrolled thyroid disease may manifest cardiovascular, pulmonary, and electrolyte disturbances that should be managed prior to elective surgery.

  4. Patients with hypercalcemia most often have underlying parathyroid disease or malignancy. Symptomatology will vary with the acuity and severity of calcium elevation. Hypocalcemia is less common, but in severe cases can cause neuromuscular irritability, laryngospasm, and seizures.

  5. Patients with adrenal insufficiency may develop weakness, fatigue, dehydration, and hyponatremia with surgical stress. These patients require supplemental glucocorticoids and, in some situations, supplemental mineralocorticoids.

  6. Adrenal cortical tumors and hyperplasia can produce excessive secretion of cortisol, aldosterone, and androgens, resulting in hyperglycemia, hypertension, hypokalemia, metabolic alkalosis, and hirsutism.

  7. Pheochromocytomas are neuroendocrine tumors arising from chromaffin cells of the adrenal medulla. Surgery can stimulate secretion of vasoactive substances, including catecholamines, resulting in difficult-to-control tachycardia and hypertension.

  8. Pituitary lesions may cause local mass effect or pituitary hormonal hypersecretion or hyposecretion. Prolactinomas are the most common type of functional pituitary mass. For anesthesiologists, the most challenging condition is acromegaly caused by excess growth hormone production and secretion. Patients with Cushing’s disease will present with hypertension, hyperglycemia, and electrolyte disturbance.

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INTRODUCTION

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Endocrine conditions are common, with a high prevalence in the population.1 Diabetes mellitus is the most common endocrine condition, followed by thyroid-related diseases. This chapter reviews fundamental endocrine physiology as well as endocrine pathophysiology encountered in the surgical patient, either as a comorbid condition or as the surgical target. Chapter 55 addresses management of anesthetics for endocrine surgery along with issues surrounding the management of anesthetics for patients presenting with endocrine disease as a comorbid condition.

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DIABETES MELLITUS

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EPIDEMIOLOGY AND CLASSIFICATION

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Diabetes mellitus (DM) is generally classified into four different categories: type 1 diabetes mellitus (DM1), type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM), and other types of DM due to specific causes.2-4 The types most commonly encountered by the anesthesiologist are DM1 and DM2 (Table 12-1).

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Table Graphic Jump Location
Table 12-1Diabetes Mellitus: Type 1 Versus Type 2

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