Author(s): S Jablonska, A Rūtiņš, M Rikmane, D Jakovels, I Konrāde and A Ozoliņa

Abstract: Background: An ACTH-producing tumor is a rare type of endocrine pathology. This case report highlights the importance of a multidisciplinary approach in the diagnosis, surgical management, and anesthesia care for a patient with ectopic ACTH-producing tumor. Laparoscopic mono- or bi-lateral adrenalectomy under general anesthesia is the gold standard for treating Cushing's syndrome. However, preoperative assessment and preparation, intraoperative management of electrolyte and homeostasis corrections, difficult airway management, and postoperative glucocorticoid supplementation are essential to prevent life-threatening complications, such as arrhythmias and adrenal crisis.Case presentation: Female, 41 years old presented to the emergency department with symptoms of progressive weakness, pressuring sensation in the head and eyes, fogginess and swelling of legs. Diagnostic tests revealed severe hypokalaemia 2,37 mmol/l, increased ACTH 393.0 pg/ml and cortisol 73.1 mkg/dl plasma levels with pituitary microadenoma in MRI scan were discovered. Consequently, diagnosis were: ectopic ACTH-producing tumor, Cushing's syndrome. Severe hypokalaemia. Glucocorticosteroid-induced diabetes mellitus, secondary transient hypothyroidism, secondary hyperparathyroidism. Vitamin D deficiency. Even though ACTH producing site was not localised, there was made decision to perform bilateral laparoscopic adrenalectomy, because her condition and laboratory tests worsened with persistent hypokalemia. Preoperatively, potassium supplementation was not successful and with sever hypokalemia 2.06 mmol/L mmol/l and metabolic alkalosis Ph 7.53 the patient underwent general anaesthesia. Continuous infusion of Potassium and Hydrocortisone was provided. Overall, patient’s condition during the surgery was stable and after the extirpation of both adrenal glands, hemodynamic fluctuations were not observed. However, the patient developed hemorrhagic shock and underwent emergency splenectomy in the intensive care unit. Afterall, Potassium, ACTH and cortisol plasma levels started to improve in the next postoperative days. The patient was discharged from the hospital at 7th postoperative day.Conclusion: This case demonstrates that the diagnosis and treatment of ectopic ACTH - producing tumor requires the involvement of multidisciplinary team and extraordinary decisions can be helpful. Bilateral laparoscopic adrenalectomy without identification of the primary ectopic ACTH-producing tumor under general anaesthesia with precise electrolyte and glucocorticoid supplementation was the right decision in this case.

DOI: 10.22271/27080056.2024.v6.i1b.82

Pages: 72-77 | Views: 350 | Downloads: 119

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