TY  - CHAP
M1  - Book, Section
TI  - The Patient With Endocrine Disease
A1  - Alexanian, Sara
A1  - Peterfreund, Robert A.
A1  - Lee, Stephanie L.
A2  - Longnecker, David E.
A2  - Mackey, Sean C.
A2  - Newman, Mark F.
A2  - Sandberg, Warren S.
A2  - Zapol, Warren M.
PY  - 2017
T2  - Anesthesiology, 3e
AB  - KEY  POINTSEndocrine  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.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.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.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.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.Adrenal  cortical  tumors  and  hyperplasia  can  produce  excessive  secretion  of  cortisol,  aldosterone,  and  androgens,  resulting  in  hyperglycemia,  hypertension,  hypokalemia,  metabolic  alkalosis,  and  hirsutism.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.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.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1144112818
ER  -