CUSHINGS-DISEASE TREATED BY TRANS-SPHENOIDAL SELECTIVE ADENOMECTOMY IN MID-PREGNANCY

The clinical course and diagnosis of a patient with Gushing's disease complicated by pregnancy is described, and the anaesthetic management of trans-sphenoidal selective adenomectomy performed during the second trimester outlined. Problems included obesity, diabetes, hypertension and a suboptimal airway. Fibreoptic awake intubation and intravenous anaesthesia were used. Insulin requirements decreased substantially af ter surgery. Early administration of hydrocortisone af:er surgery avoi ded the risk of an addisonian crisis but delayed biochemical confirmat ion of a metabolic cure.