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Fig. 6. Sagittal unenhanced T1 MRI (A) and coronal unenhanced T2 MRI (B) of a massive multilobed growth hormone (GH)-secreting tumor presenting with loss of vision. Chiasmal compression is best seen in (B). Note, too, the invasion of the cavernous sinus with engulfing of the left carotid. A tumor like this is a challenge by any route and is best tackled by both transcranial and transsphenoidal approaches, followed by radiotherapy.

nathism and macroglossia seen in acromegaly, the pharyngeal and laryngeal tissues are thickened, resulting in a decreased laryngeal aperture and hypertrophy of the peri-epiglottic folds. Recurrent laryngeal nerve palsy has been reported, and the thyroid enlargement seen in 25% of patients may cause tracheal compression. It is therefore not surprising that difficulties of airway management and tracheal intubation are commonly reported. Careful assessment of the airway is vital and may require indirect laryngoscopy preoperatively.

Obstructive sleep apnea is a common complication of acromegaly and reflects the airway pathology and results in a three-fold increase in the risk of death from respiratory failure. A history of loud snoring, apnea, and daytime hypersomno-lence should alert the anesthetist of the possibility of sleep apnea, and a sleep study performed if indicated.

Hypertension occurs in 30% of patients with acromegaly, but, unlike CD, it is usually responsive to antihypertensive treatment. Ventricular hypertrophy and interstitial fibrosis are common in long-standing acromegaly and may result in reduced ventricular function.

Glucose intolerance is a frequent finding, and frank diabetes mellitus (DM) occurs in 25% of patients.

Cushing's Disease

Hypertension occurs in approx 85% of patients with CD and is the result of increased mineralocorticoid activity and an increased plasma volume. It is often relatively refractive to treatment. The left ventricular hypertrophy seen in the condition is believed to be partially attributable to the effects of hypertension and to excessive levels of circulating cortisol.

Obstructive sleep apnea is found in 30% of patients with CD and may be related to the centripetal obesity that occurs; the latter may also contribute to gastroesophageal reflux that is commonly encountered. Preoperative administration of H2 antagonists is often warranted.

Glucose intolerance or frank diabetes mellitus (DM) occurs in 60% of patients and, with the immunosuppressive action of the high levels of circulating glucocorticoids, coexisting infection is common.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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