PREMANAGEMENT OF ELECTROLYTE AND FLUID DISORDERS FOR PITUITARY TUMOURS: A CASE REPORT Kambria Erdi1, Reza W. Sudjud2, Erwin Pradian2, Iwan Fuadi2, Suwarman2
1. Resident, Department of Anesthesiology and Intensive Care, Padjadjaran University
2. Consultant, Department of Anesthesiology and Intensive Care, Padjadjaran University
Abstract
Introduction: Pituitary macroadenoma is a benign tumor in the suprasellar region that most commonly occurs in adults where it can exceed 10 mm in size. Pituitary hormone deficiency leading to severe hyponatremia as a result of nonfunctional pituitary macroadenoma is quite rare presentation in clinical practice.
Case: A 54 years old man complained of headache since 6 months ago and visual field disturbances since 1 month ago. On physical examination, it was found that the patient was in a polyuric condition, showed signs of dehydration, and bitemporal hemianopy. On laboratory examination, it was found that there was a decrease in sodium levels and plasma osmolarity. On Contrast MRI, tumor was found in the sellar region due to pituitary macroadenoma. The patient was diagnosed with SOL Supratentorial at Sellar Region due to Pituitary Macroadenoma and Hyponatremia due to Cerebral Salt Wasting Syndrome (CSW).
Discussion: Some cases with NFPA have several symptoms, including the main complaints related to mass effects and pituitary insufficiency. Hyponatremia is often a manifestation of serious underlying disorder and requires careful preoperative evaluation. SIADH and CSW are very difficult to distinguish so that the diagnosis must be made precisely because the management of the two conditions is very different.
Conclusion: The preoperative assessment of patients with pituitary macroadenoma undergoing pituitary surgery requires multidisciplinary cooperation to assess the patient^s condition and accompanying diseases, both chronic disease and tumor induced disease. Improper assessment will lead to inappropriate management. Optimal preparation will increase the success of the operation.
Keywords: Cerebral salt wasting syndrome, hyponatremia, hypopituitarism, pituitary macroadenoma
