Anaes · Neuroanaesthesia
Transsphenoidal pituitary surgery: hormones, airway, and DI
Also known as TSS pituitary · Acromegaly anaesthesia · Postop diabetes insipidus
Exam-exhaustive anaesthesia for endoscopic and microscopic transsphenoidal pituitary surgery: hormone phenotype map (acromegaly airway, Cushing comorbidity, hypopituitarism), steroid cover, still bloodless field, smooth emergence for early vision check, CSF leak precautions, and structured diabetes insipidus recognition with desmopressin for ANZCA Final and equivalents.
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Red flags
- Acromegaly may hide a difficult airway — plan awake/advanced airway if indicated.
- Secondary adrenal insufficiency risk — peri-operative glucocorticoid cover when appropriate.
- Post-op DI: polyuria with rising Na — desmopressin thoughtfully to avoid overshoot hyponatraemia.
- CSF leak and meningitis risk with aggressive positive pressure or Valsalva if defect present.
- Apoplexy and acute visual loss are neurosurgical emergencies.
Meet the patient
A 48-year-old man with acromegaly and a macroadenoma is listed for endoscopic transsphenoidal resection. He snores heavily, his tongue fills his mouth, and his morning cortisol is borderline low. The examiner is not testing whether you can name a nasal endoscope — it is testing whether you can secure this airway, cover the cortisol axis, keep the field still, and catch diabetes insipidus before the sodium climbs.[1]
References4ShowHide
- [1]Dunn LK, Nemergut EC Anesthesia for transsphenoidal pituitary surgery Curr Opin Anaesthesiol, 2013.PMID 23963232
- [2]Goettel N et al. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial Br J Anaesth, 2016.PMID 27099154
- [3]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848
- [4]Fountas A et al. Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: a systematic review and meta-analysis. Eur J Endocrinol, 2024.PMID 38996052