Paratiroid Adenomu Olan Gebede Paratiroid Cerrahisi İçin Anestezi Yönetimi
Özet
Primer hiperparatiroidizm (PHP), gebelikte nadir görülen ancak hem anne hem de fetüs için ciddi riskler taşıyan bir endokrin bozukluktur. Bu vaka sunumunda, 15 haftalık gebe bir hastada saptanan semptomatik paratiroid adenomunun multidisipliner bir yaklaşımla başarılı cerrahi yönetimi ele alınmıştır. Otuz yaşında ve 15 haftalık gebe olan hastada karın ağrısı ve yüksek serum kalsiyum düzeyi (14.5 mg/dL) tespit edilmiştir. Yapılan tetkikler ve ultrasonografi sonucunda sol paratiroid bezi komşuluğunda adenom ile uyumlu lezyon saptanmış, fetusta gelişme geriliği riski nedeniyle cerrahi kararı alınmıştır. İkinci trimester, organogenezin tamamlanmış olması ve preterm eylem riskinin düşüklüğü sebebiyle cerrahi için en uygun dönem olarak tercih edilmiştir. Operasyon, propofol, roküronyum ve remifentanil indüksiyonunu takiben sevofluran idamesiyle genel anestezi altında, minimal invaziv paratiroidektomi yöntemiyle gerçekleştirilmiştir. Postoperatif dönemde kalsiyum ve parathormon düzeyleri normale dönen hasta, herhangi bir komplikasyon gelişmeden taburcu edilmiştir. Sonuç olarak, semptomatik seyreden veya kalsiyum düzeyleri kontrol edilemeyen gebe hastalarda, fetal morbidite ve mortaliteyi azaltmak adına cerrahi müdahale altın standarttır. Anestezi yönetiminde ise hiperkalseminin fizyolojik etkileri ve gebeliğe özgü hassasiyetler dikkatle yönetilmelidir.
Primary hyperparathyroidism (PHP) is a rare endocrine disorder during pregnancy that poses significant risks to both maternal and fetal health. This case report discusses the successful surgical management of a symptomatic parathyroid adenoma in a 15-week pregnant patient through a multidisciplinary approach. A 30-year-old patient, 15 weeks pregnant, presented with abdominal pain and elevated serum calcium levels (14.5 mg/dL). Following diagnostic tests and ultrasonography, a lesion consistent with a parathyroid adenoma was identified near the left parathyroid gland. Due to the risk of intrauterine growth restriction in the fetus, surgical intervention was decided. The second trimester was chosen as the optimal time for surgery because organogenesis is complete and the risk of preterm labor is lower. The procedure was performed under general anesthesia—induced with propofol, rocuronium, and remifentanil, and maintained with sevoflurane—using a minimally invasive parathyroidectomy technique. Postoperatively, the patient’s calcium and parathormone levels normalized, and she was discharged without complications. In conclusion, for pregnant patients with symptomatic PHP or uncontrollable calcium levels, surgical intervention remains the gold standard to reduce fetal morbidity and mortality. Anesthesia management must carefully address the physiological effects of hypercalcemia and pregnancy-specific sensitivities.
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