Dyer Matthew W, Gnagey Amy, Jones Bryan T, Pula Roger D, Lanier William L, Atkinson John L D, Pasternak Jeffrey J
*Mayo Clinic School of Health Sciences Departments of †Anesthesiology §Neurosurgery ‡Mayo Clinic College of Medicine, Rochester, MN.
J Neurosurg Anesthesiol. 2017 Jul;29(3):341-346. doi: 10.1097/ANA.0000000000000325.
Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are a rare cause of secondary hyperthyroidism. Anesthetic management of these patients has not been formally described in the literature.
Patients who underwent resection of a TSH-secreting pituitary adenoma during 1987 to 2012 at a single institution were identified. Preoperative thyroid hormone state, anesthetic management, and outcome were recorded. Hemodynamic associations with intraoperative events were compared between those who were hyperthyroid and euthyroid at the time of surgery.
Of 2268 patients having transsphenoidal resection of a pituitary tumor, 19 (0.84%) had resection of a TSH-secreting adenoma. At the time of surgery, 6 (32%) were hyperthyroid, 11 (58%) were euthyroid, and 2 (10%) were hypothyroid based on serum thyroxine concentration. General anesthesia was maintained with a potent inhaled anesthetic in all patients, and included nitrous oxide in 18 of 19 (95%). Seventeen (90%) had an arterial catheter placed for surgery. Only 1 patient (5%) required an intraoperative blood transfusion. There were no significant differences in heart rate or blood pressure at induction of anesthesia, upon intranasal injection of local anesthetic containing epinephrine, or upon emergence from anesthesia, between patients who were chemically hyperthyroid or euthyroid. Twelve of 19 (63%) had tumor extension beyond the sella turcica. Common complications were nausea and vomiting (42%), diabetes insipidus (32%), and temporary or permanent hypopituitarism (42%).
Patients having resection of TSH-secreting pituitary adenomas can present in any thyroid state. An awareness of risks and potential complications in patients with TSH-secreting adenomas can help tailor perioperative care.
分泌促甲状腺激素（TSH）的垂体腺瘤是继发性甲状腺功能亢进的罕见病因。文献中尚未正式描述这些患者的麻醉管理。
确定1987年至2012年在单一机构接受分泌TSH垂体腺瘤切除术的患者。记录术前甲状腺激素状态、麻醉管理及结果。比较手术时甲状腺功能亢进和甲状腺功能正常患者术中事件的血流动力学关联。
在2268例行垂体瘤经蝶窦切除术的患者中，19例（0.84%）接受了分泌TSH腺瘤切除术。手术时，根据血清甲状腺素浓度，6例（32%）甲状腺功能亢进，11例（58%）甲状腺功能正常，2例（10%）甲状腺功能减退。所有患者均使用强效吸入麻醉药维持全身麻醉，19例中有18例（95%）使用氧化亚氮。17例（90%）患者术中放置了动脉导管。仅1例患者（5%）需要术中输血。化学性甲状腺功能亢进或甲状腺功能正常的患者在麻醉诱导时、鼻内注射含肾上腺素的局部麻醉药时或麻醉苏醒时，心率或血压无显著差异。19例中有12例（63%）肿瘤侵犯超出蝶鞍。常见并发症为恶心呕吐（42%）、尿崩症（32%）以及暂时性或永久性垂体功能减退（42%）。
接受分泌TSH垂体腺瘤切除术的患者甲状腺状态各异。了解分泌TSH腺瘤患者的风险及潜在并发症有助于制定围手术期护理方案。
