Rajat Choudhuri, Sandeep Kr. Kar, Dhiman Adhikari and Sabyasachi Sinha
Hypoplastic pituitary, a rare entity in itself and when presented to us requires a detailed evaluation and postoperative follow up. We are presenting a 48 year old lady who is short statured posted for epigastrichernioplasty. Detailed evaluation revealed secondary hypothyroidism, difficult airway, cardiomegaly, pericardial effusion, secondary adrenocortical insufficiency, growth hormone deficiency. CT scan of brain revealed cerebrospinal fluid filled sellar region and magnetic resonance imaging proved hypo plastic pituitary. After optimization with L-thyroxine she was planned for balanced general anaesthesia with epidural analgesia under steroid coverage. Peroperatively we faced resistant hypotension and due to inadequate reversal she was shifted to intensive care unit on ventilator. Subsequently we proved that her postoperative adrenocorticotropic hormone and cortisol level were low. However 24 hours later she could be extubated and finally she was discharged one week after the operation. However such cases are a challenge to the attending anaesthesiologist and as there is no strict protocol for anaesthetizing such a rare entity we have thought for detailing the case.
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