Chiaghana Chukwudi O, Bauerfeind Julia M, Sulek Cheri A, Goldstein J Christopher, Awoniyi Caleb A
Department of Anesthesiology, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32608, USA.
Department of Anesthesiology, NF/SG Veterans Health System, Gainesville, FL, 32608, USA.
J Med Case Rep. 2017 Jun 24;11(1):169. doi: 10.1186/s13256-017-1338-8.
Acromegaly is a rare syndrome in which there is unregulated hypersecretion of growth hormone. The anesthetic management of patients with this disorder is particularly challenging due to pre-existing cardiovascular and respiratory dysfunction, as well as recognized difficulties with airway management. Because of the insidious progression of the disease and the presence of nonspecific signs and symptoms, diagnosis is often made late when characteristic acromegalic features become apparent.
We report the management of a 35-year-old African American man with previously undiagnosed acromegaly, who underwent a general anesthetic for same day surgery. Subtle physical features and difficult endotracheal intubation raised our suspicion for the diagnosis of acromegaly. Following an uncomplicated postoperative course he underwent workup for the disease, which was confirmed. In addition, brain magnetic resonance imaging showed a pituitary adenoma. A subsequent transsphenoidal hypophysectomy was performed successfully.
This case underscores the notable absence of recognizing the clinical presentation of acromegaly in this patient by his primary care physician, and the value of thorough history taking, vigilance, and observation in making a new diagnosis that has the potential to alter a patient's health care and mitigate impending morbidity and/or mortality.
肢端肥大症是一种罕见的综合征，其生长激素分泌不受调节且分泌过多。由于患者存在心血管和呼吸功能障碍，以及公认的气道管理困难，对患有这种疾病的患者进行麻醉管理具有特别大的挑战性。由于该疾病进展隐匿且存在非特异性体征和症状，通常在特征性肢端肥大症特征明显时才做出诊断，此时往往已为时过晚。
我们报告了一名35岁非裔美国男性的治疗情况，该男性此前未被诊断出患有肢端肥大症，因当日手术接受全身麻醉。细微的身体特征和困难的气管插管引发了我们对肢端肥大症诊断的怀疑。术后恢复过程顺利，随后他接受了针对该疾病的检查，结果得到确诊。此外，脑部磁共振成像显示有垂体腺瘤。随后成功进行了经蝶窦垂体切除术。
本病例凸显了该患者的初级保健医生明显未识别出肢端肥大症的临床表现这一情况，以及详细询问病史、保持警惕和进行观察对于做出可能改变患者医疗护理并减轻即将发生的发病率和/或死亡率的新诊断的价值。
