Guo Peng, Xu Zeng-Jun, Hu Chang-En, Zheng Yue-Ying, Xu Dan-Feng
Department of Anesthesiology, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China.
Department of Anesthesiology, the First Affiliated Hospital of Zhejiang University, Hangzhou310000, Zhejiang Province, China.
World J Clin Cases. 2019 Mar 6;7(5):663-667. doi: 10.12998/wjcc.v7.i5.663.
Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache, hypertension, obesity, visual disturbances, cerebrospinal fluid (CSF) rhinorrhoea, or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure.
A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed, with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally.
This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.
空蝶鞍综合征是一种垂体萎缩或扁平的病症。空蝶鞍综合征患者常表现为头痛、高血压、肥胖、视觉障碍、脑脊液鼻漏或内分泌功能障碍。在此，我们报告一例罕见的空蝶鞍综合征病例，该病例是在患者经历术后低血压和呼吸衰竭后发现的。
一名60岁男性因左肩痛入院进一步检查。他由骨科团队进行评估，并安排了左锁骨内固定手术。实施了神经阻滞全身麻醉。术后他的血压持续下降。进行了内分泌检查，结果支持垂体功能减退伴皮质醇减少症和甲状腺功能减退症的诊断。脑部磁共振成像显示蝶鞍扩大并充满脑脊液，确诊为空蝶鞍综合征。患者开始接受内分泌替代治疗。患者最终恢复意识并自主呼吸。
本病例强调了围手术期在呼吸和血流动力学衰竭背景下考虑垂体激素不足的重要性。
