Fungsional Makroadenoma Hipofisis dengan Manifestasi Akromegali dan Komplikasi Diabetes Insipidus Pascaoperasi

Abstract

Akromegali sebagai manifestasi klinis dari fungsional makroadenoma hipofisis adalah suatu kasus yang jarang terjadi. Laki-laki 28 tahun dikonsulkan dengan space occupying lesion serebri suprasellar dengan differensial diagnosis meningoma atau adenoma yang akan dilakukan reseksi tumor. Pada pemeriksaan preoperasi didapatkan pasien dengan tanda-tanda yang mengarah ke akromegali seperti rahang yang lebih menonjol, ukuran hidung, lidah, dan tangan yang relatif lebih besar dari orang normal namun tanpa gejala obstructive sleep apnea. Intraoperasi pasien berhasil diintubasi dengan video laringoskop dengan persiapan fiber optik. Pasca-operatif pasien mengalami diabetes insipidus dan dipindahkan ke ruangan dari ICU pada hari ke tujuh pasca-operatif pada saat sudah bebas dari vasopressin. Ada beberapa hal yang harus dipertimbangkan pada penatalaksanaan pasien dengan makroadenoma hipofisis, seperti penatalaksanaan jalan nafas jika terjadi akromegali dan komplikasi diabetes insipidus pacaoperasi

Functional Pituitary Macroadenoma with Acromegaly and Complications of Postoperative Diabetes Insipidus

Abstract

Acromegaly as a clinical manifestation of functional pituitary macroadenoma is a rare case. A 28-year-old male was consulted with a space occupying suprasellar cerebral lesion with a differential diagnosis of meningioma or adenoma which would require tumor resection. On the pre-operative examination, it was found that patients with signs and symptom of acromegaly such as a more prominent jaw, the size of the nose, tongue, and hands were relatively larger than normal people but without symptoms of obstructive sleep apnea. Intraoperatively, the patient was successfully intubated with a video laryngoscope with a fiber optic preparation. Post-operatively the patient developed diabetes insipidus and was transferred to the room from ICU on the seventh postoperative day when she was free of vasopressin. There are several things that should be considered during the perioperative management of patients with pituitary macroadenoma, such as airway management if there is acromegaly and diabetes insipidus as a postoperative complication.