Laparoscopic Bilateral Adrenalectomy in a patient of Cushing syndrome: A Challenge for the Anaesthesiologist

• Main Authors: Uma K Dahanukar, Kedar S Joshi, Vishakha Desai, Usha D Padhye, Arun D Joshi, A M Deshpande
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2007-01-01
• Series: Indian Journal of Anaesthesia
• Subjects: Cushing syndrome; Laparoscopic adrenalectomy; Pulmonary oedema; Metabolic alkalosis; Hypokalemia
• Online Access: http://www.ijaweb.org/article.asp?issn=0019-5049;year=2007;volume=51;issue=2;spage=143;epage=143;aulast=Dahanukar

We present a case of Cushing syndrome who underwent laparoscopic bilateral adrenalectomy and discuss her intraoperative management and postoperative course in ICU, especially pulmonary oedema, that occurred within 3 hours after resection (half life of cortisol is 80-110 minutes). [1] She was diagnosed to have bilateral adrenal hyperplasia with no pituitary involvement on CT scan. Preoperative workup revealed hypokalemia, anaemia, hypertension and hyperglycemia. She was posted for laparoscopic bilateral adrenalectomy. She received general anaesthesia; we did not give epidural analgesia as the patient had fracture of body of L1 vertebrae. Her intra-operative course was uneventful. Post-operative concerns included acute adrenal insufficiency, hypoglycaemia, hypotension and hyperkalemia, which were successfully managed in ICU. Patient was then given oral corticosteroids. One month later she was reassessed and was in better health.