Therapeutic approach of children with endocrine diseases in otorhinolaryngoiatric surgery

Almost all endocrine disorders may cause adverse complications or a difficult postoperative course if they are not recognized or adequately managed. Diabetes is the most commonly encountered endocrinopathy and there is increasing evidence that maintenance of normal blood glucose in the perioperative period is necessary to reduce adverse events. The perioperative management of diabetes should be based on the type of diabetes, the medications taken and degree of diabetes control. Thyrotoxicosis is a potentially severe condition that requires medical intervention before surgery. The preparation of a patient with hyperthyroidism depends on the time available before surgery and on the severity of the thyrotoxicosis. Generally, treatment involves a combination of medications that influence the synthesis, secretion and peripheral actions of thyroid hormones. Patients with mild hypothyroidism can undergo elective or emergency surgery without specific perioperative preparation. In case of adrenal insufficiency, supplementation of glucocorticoids (and possibly mineralocorticoids) should be adequately given and individualized on the basis of size and the type of surgical procedure to be performed. Finally, the management of children with diabetes insipidus, before or after a surgical procedure, or with the syndrome of inappropriate secretion of ADH is complicated and may cause severe electrolytic imbalances as well as problems of over- or under-hydration which can be difficult to treat. \ua9 Copyright 2006, CIC Edizioni Internazionali, Roma