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Hypopituitarism is a decreased secretion of pituitary hormones. It is especially concerning during surgery and anesthesia if it results in adrenal insufficiency, hypothyroidism, or diabetes insipidus. Common causes in children include pituitary tumor and/or treatment, traumatic brain injury, and empty sella syndrome. Perioperative management includes recognition of clinical symptoms, such as hypotension, fatigue, polydipsia, and increased urine output. Unrecognized adrenal insufficiency may result in significant morbidity or mortality. Intraoperative treatment may involve stress-dose corticosteroids, careful fluid management, and desmopressin. This chapter uses the case study of a 9-year-old boy who presents for bilateral removal of tibial orthopedic hardware to illustrate the concepts. |
