Preoperative Assessment of Patients with Other Endocrine Disorders

The rate of rise of endocrine disease in the general population is staggering. Roughly 1 in 10 Americans have been diagnosed with an endocrine disorder, the vast majority of which is diabetes mellitus. This is closely followed by thyroid disorders and also includes patients with disease of the adrenal glands, parathyroid glands and pituitary. These individuals present for surgery with a multitude of metabolic and electrolyte derangements. Their disease may be complicated by obesity and severe, poorly controlled hypertension. Frequently, end-organ damage resulting from long-standing endocrinopathy is also present, including renal and cardiovascular abnormalities. These patients often present for surgery with undiagnosed disease due to the subtle physiologic alterations characteristic of many endocrine disorders. Identification and optimization of these individuals is paramount prior to surgery to avoid intraoperative and postoperative complications. This article reviews the wide-ranging challenges unique to endocrine disorders in the perioperative period and specifically addresses preoperative concerns and patient optimization. This review contains 4 figures, 5 tables, and 42 references. Keywords: hypothyroidism, hyperthyroidism, thyroid storm, myxedema coma, hyperparathyroidism, hypoparathyroidism, hypercortisolism (Cushing’s Syndrome), hyperaldosteronism, adrenal insufficiency (Addison’s Disease), pheochromocytoma