Zhao KM, Hu JS, Zhu SM, Wen TT, Fang XM. Persistent postoperative hypotension caused by subclinical empty sella syndrome after a simple surgery: A case report. World J Clin Cases 2023; 11(24): 5817-5822 [PMID: 37727724 DOI: 10.12998/wjcc.v11.i24.5817]
Corresponding Author of This Article
Xiang-Ming Fang, MD, Chief Doctor, Professor, Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. xmfang@zju.edu.cn
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kang-Mei Zhao, Sheng-Mei Zhu, Ting-Ting Wen, Xiang-Ming Fang, Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Jia-Sheng Hu, Department of Anesthesiology, Sanmen People’s Hospital, Sanmen 317100, Zhejiang Province, China
Author contributions: Zhao KM, Hu JH and Zhu SM were the patient’s anesthesiologists, and they reviewed the literature and drafted the text of the manuscript; Wen TT prepared the table and the figure; Fang XM and Wen TT reviewed the literature and revised the manuscript; all authors reviewed the manuscript and issued final approval of the version for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Ming Fang, MD, Chief Doctor, Professor, Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. xmfang@zju.edu.cn
Received: June 10, 2023 Peer-review started: June 10, 2023 First decision: June 21, 2023 Revised: July 10, 2023 Accepted: August 1, 2023 Article in press: August 1, 2023 Published online: August 26, 2023 Processing time: 75 Days and 23.3 Hours
Abstract
BACKGROUND
Empty sella is an anatomical and radiological finding of the herniation of the subarachnoid space into the pituitary fossa leading to a flattened pituitary gland. Patients with empty sella may present with various symptoms, including headache due to intracranial hypertension and endocrine symptoms related to the specific pituitary hormones affected. Here, we report a female patient who developed persistent postoperative hypotension caused by subclinical empty sella syndrome after a simple surgery.
CASE SUMMARY
A 47-year-old woman underwent vocal cord polypectomy under general anesthesia with endotracheal intubation. She denied any medical history, and her vital signs were normal before the surgery. Anesthesia and surgery were uneventful. However, she developed dizziness, headache and persistent hypotension in the ward. Thus, intravenous dopamine was started to maintain normal blood pressure, which improved her symptoms. However, she remained dependent on dopamine for over 24 h without any obvious anesthesia- and surgery-related complications. An endocrine etiology was then suspected, and further examination showed a high prolactin level, a low normal adrenocorticotropic hormone level and a low cortisol level. Magnetic resonance imaging of the brain revealed an empty sella. Therefore, she was diagnosed with empty sella syndrome and secondary adrenal insufficiency. Her symptoms disappeared one week later after daily glucocorticoid supplement.
CONCLUSION
Endocrine etiologies such as pituitary and adrenal-related dysfunction should be considered in patients showing persistent postoperative hypotension when anesthesia- and surgery-related factors are excluded.
Core Tip: Perioperative hypotension is commonly caused by hypovolemia, reduced vascular tone and cardiac insufficiency. Occasionally, perioperative hypotension can be attributed to an endocrine etiology such as empty sella syndrome, as in our patient, which led to decreased adrenocorticotropic hormone secretion and secondary adrenal insufficiency. Therefore, clinicians managing persistent hypotension should consider the endocrine dysfunctions when common hypotension causes are excluded.
