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Cushing's syndrome






  • Possible difficult airway: obesity, obstructive sleep apnea (OSA)

  • Cardiovascular: 

    • Left ventricular hypertrophy, pulmonary hypertension/right ventricular failure, systolic & diastolic dysfunction

    • Hypertension, volume overload (↑ renin & glucocorticoid vascular reactivity)

  • Respiratory: possible OSA

  • Metabolic:

    • Hypokalemic metabolic alkalosis: mineralcorticoid effect of glucocorticoids

    • Diabetes: insulin deficiency

    • Osteoporosis: need for careful positioning 

  • CNS: possible psychosis

  • Pharmacologic considerations: 

    • Perioperative steroid replacement (stress dose & post-operative replacement) 

    • Sensitivity to neuromuscular blockers (due to possible muscle weakness, hypokalemia, catecholamines) 

  • Cancer considerations (mass effect, metabolic derangements, metastases, medications) if primary Cushing's (adrenal adenoma) 





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