Sheehan’s Syndrome in a Fifty-Six-Year-Old Woman Presenting With a Retroperitoneal Mass: Perioperative Management During a Major Surgery

Abstract

Patients with Sheehan's syndrome (SS) can present with adrenal crisis, myxedema coma, hypoglycemia, and hyponatremia, which could be triggered by an infection or surgery. For the endocrinologist, a patient with SS who is scheduled for surgery presents a significant challenge as more likely to experience delayed emergence from anesthesia, hypotension that does not respond to the standard regimen, a decrease in core body temperature, and a decreased need for anesthetic drugs due to reduced metabolism. Here, to emphasize the significance of perioperative management to reduce the risk of morbidity and mortality from a potential adrenal crisis, we report the successful perioperative management of a 56-year-old woman with SS undergoing major surgery for the resection of a retroperitoneal tumor. The management plan for this patient comprised a perioperative intravenous hydrocortisone supplementation and thyroxine tablets on the morning of the procedure. In the operating room, the patient was started on norepinephrine, and she was given intravenous (IV) crystalloids and albumin. Healthcare providers should be aware of the perioperative risk of SS. No consensus, guidelines, or randomized trials for the safe perioperative management of patients with SS have been identified by a thorough review of the literature. Because of this, the perioperative care of these patients necessitates the utmost caution in addition to successful management based on close coordination between the endocrinologist, surgeon, and anesthetist.