Preoperative Management

In general, nonfunctioning pituitary tumors present when they are of sufficient size to produce chiasmal compression with or without compression syndromes of the cavernous sinus or suprachiasmal structures. It is essential for the anesthetist to be aware that raised intracranial pressure (ICP) may be present because of either the large size of the tumor or hydrocephalus resulting from obstruction of cerebrospinal fluid (CSF) at the third ventricle. In contrast, functioning pituitary tumors are usually microadenomas and the anesthetist's attention should be directed toward assessment of the clinical effects of hormonal hypersecretion.

It therefore follows that, in addition to the routine preoperative assessment performed on patients undergoing a neurosurgical procedure, the anesthetist must specifically assess the patient's visual function and endocrine status, the clinical effects of hormonal hypersecretion (or hyposecretion), as well as looking for signs of raised ICP.

Patients with acromegaly and CD are likely to be suffering from co-existing systemic complications of their disease and must be assessed accordingly (see Chapters 3 and 4).

Acromegaly

GH hypersecretion affects not only the extremities but also the tissues of the mouth, tongue, pharnyx, and larynx. In addition to the almost invariable prog-

Fig. 5. (A) Unenhanced coronal T1 MRI of >10 mm GH-secreting adenoma. (B) Enhanced coronal T1 MRI of the lesion in (A).

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