# Growth Hormone-Secreting Pituitary Adenoma and Difficult Airway: Awake Oral Fiberoptic Intubation Approach

## TL;DR

This paper discusses the challenges of managing a difficult airway in a patient with acromegaly and the use of awake oral fiberoptic intubation during pituitary tumor surgery.

## Contribution

The paper presents a case emphasizing the effectiveness of awake oral fiberoptic intubation in managing airway difficulties during transnasal pituitary surgery in acromegaly patients.

## Key findings

- Awake fiberoptic intubation is a recommended strategy for securing a difficult airway in acromegaly patients.
- Transnasal transsphenoidal excision of pituitary adenoma is a minimally invasive surgical technique with advantages over traditional craniotomy.
- Preoperative planning is crucial for managing airway challenges in acromegaly patients undergoing pituitary surgery.

## Abstract

Acromegaly is a rare endocrine disorder characterized by excessive growth hormone (GH) secretion, usually due to a pituitary adenoma. This condition leads to progressive somatic disfigurement, including enlarged hands, feet, and facial features, and is often associated with systemic complications such as cardiovascular disease, diabetes mellitus, and sleep apnea. Anesthesia for patients with acromegaly presents unique challenges due to the characteristic anatomical and physiological changes associated with the condition. Acromegaly, resulting from excessive GH secretion, often leads to difficult airway management, cardiovascular complications, and metabolic abnormalities. Transnasal transsphenoidal excision of pituitary adenoma is a minimally invasive surgical technique employed to remove pituitary tumors. This approach, which utilizes the nasal passages and sphenoid sinus to access the pituitary gland, offers several advantages, including reduced recovery time, minimal scarring, and lower risk of complications compared to traditional craniotomy. Awake fiberoptic intubation is one of the recommended strategies to secure an expected difficult airway such as in acromegaly. This case highlights the importance of preoperative planning and the role of an oral fiberoptic technique in managing the airway in surgeries like the transnasal approach.