Cushing's syndrome
Considerations
-
Possible difficult airway: obesity, obstructive sleep apnea (OSA)
-
Cardiovascular:
-
Left ventricular hypertrophy, pulmonary hypertension/right ventricular failure, systolic & diastolic dysfunction
-
Hypertension, volume overload (↑ renin & glucocorticoid vascular reactivity)
-
-
Respiratory: possible OSA
-
Metabolic:
-
Hypokalemic metabolic alkalosis: mineralcorticoid effect of glucocorticoids
-
Diabetes: insulin deficiency
-
Osteoporosis: need for careful positioning
-
-
CNS: possible psychosis
-
Pharmacologic considerations:
-
Perioperative steroid replacement (stress dose & post-operative replacement)
-
Sensitivity to neuromuscular blockers (due to possible muscle weakness, hypokalemia, catecholamines)
-
-
Cancer considerations (mass effect, metabolic derangements, metastases, medications) if primary Cushing's (adrenal adenoma)