Perioperative care of patients with endocrine disease Anaesthesia for patients with pituitary disease

endocrine tissue, and contains a number of nuclei that have either a direct (neuronal) or indirect (vascular) communication with the pituitary gland. The pituitary gland is similarly a composite of endocrine and nervous tissue that is located at the base of the brain and connected to the hypothalamus by the pituitary stalk. It weighs less than 1 g under normal circumstances, and lies within the sella turcica, a bony fossa of the skull base. The roof of the pituitary fossa is created by an incomplete fold of dura, the diaphragma sella, through which passes the pituitary stalk. The fossa is limited posteriorly by the clivus and both anteriorly and inferiorly by the bony air sinuses of the sphenoid bone. Important anatomical relationships of the pituitary gland are shown in Figure 1.1 [2]. Laterally on either side lie the cavernous sinuses, various cranial nerves and beyond them the temporal lobes. Superiorly are found the pituitary stalk, the diaphragma sella and the optic nerves/chiasm, and beyond them the hypothalamus and third ventricle. The gland itself is organised embryologically, anatomically and functionally into two parts (Figure 1.2). The anterior lobe (adenohypophysis) is derived embryologically from Rathke’s pouch, an upgrowth from the roof of the pharynx, and consists of cords of endocrine secretory tissue organised around an extensive network of sinusoids which arise from a local vascular network that extends from the hypothalamus to the anterior lobe along the pituitary stalk. Classically, cell types of the anterior lobe have been categorised histologically according to the presence and staining characteristics of intracellular granules, this being a reflection of a more fundamental functional characteristic of endocrine tissue that has differentiated into one of five secretory cell types (Table 1.1). The secretory functions of the anterior lobe are under indirect (vascular) hypothalamic control, mediated by releasing Perioperative care of patients with endocrine disease Anaesthesia for patients with pituitary disease