Anesthesia for Nelson's syndrome.

A 12 yr-old, 30 kg female child was admitted with history of bilateral adrenalectomy for Cushing’s syndrome 3 years back, following which she developed severe darkening of skin all over body and gradually progressing headache. Her endocrine profile revealed ACTH levels of 220 pg/mL (Normal = 6-76 pg/mL) with cortisol of 1.2 μg/dL (normal = 5-25 μg/dL) for which prednisolone 5 mg and fludrocortisone 50 μg daily were being supplemented. Growth hormone levels were increased (4 ng/mL; normal <2 ng/mL). Well defined hypointense mass (9 × 3 mm) arising from anterior pituitary was evident in CT scan. A diagnosis of Nelson’s syndrome was made and sublabial transsphenoidal hypophysectomy was planned. Child was rendered euthyroid on eltroxin 50 μg daily. Airway examination revealed coarse facies with Mallampati II airway.