{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:48:15Z","timestamp":1787071695822,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:p>\n                    Maintenance of homeostasis during anaesthesia in the patient with two major metabolic disorders whose systemic effects either compliment or contradict each other is a challenge to the anaesthesiologist. A 25-year-old male patient with Cushing's syndrome and known hyperhomocysteinemia was scheduled for open adrenalectomy. Both these disorders compound the hypercoagulable state and differ in glucose metabolism. In addition, obesity, difficult airway, electrolyte and metabolic derangements that accompany Cushing's syndrome warrant special attention. He was on anticoagulant therapy and inferior vena cava filter following an episode of pulmonary thromboembolism with deep vein thrombosis. Perioperative hydrocortisone was administered. Thoracic epidural catheter was placed at T10\u2013T11 interspace, standard general anaesthesia was administered without nitrous oxide. Patient was extubated following an uneventful procedure and discharged home on 10\n                    <jats:sup>th<\/jats:sup>\n                    post-operative day. Understanding the anaesthetic implications and the pathophysiological interactions of multiple metabolic disorders with a potential for multisystem involvement is key to the successful management of these patients.\n                  <\/jats:p>","DOI":"10.4103\/0019-5049.153041","type":"journal-article","created":{"date-parts":[[2015,3,12]],"date-time":"2015-03-12T02:12:59Z","timestamp":1426126379000},"page":"182-185","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Anaesthetic concerns during adrenalectomy for Cushing's syndrome with known hyperhomocysteinemia"],"prefix":"10.4103","volume":"59","author":[{"given":"Nirmala","family":"Jonnavithula","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen Reddy","family":"Elmati","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran Kumar","family":"Duddu","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PVLN","family":"Murthy","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopinath","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20251205","doi-asserted-by":"crossref","first-page":"872","DOI":"10.5858\/2007-131-872-HATAO","article-title":"Hyperhomocysteinemia and thrombosis: An overview","volume":"131","author":"Eldibany","year":"2007","journal-title":"Arch Pathol Lab Med"},{"key":"R2-20251205","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/S0140-6736(82)92749-0","article-title":"Cushing's syndrome - killing disease: Discriminatory value of signs and symptoms aiding early diagnosis","volume":"2","author":"Ross","year":"1982","journal-title":"Lancet"},{"key":"R3-20251205","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1365-2265.1994.tb02486.x","article-title":"Morbidity and mortality in Cushing's disease: An epidemiological approach","volume":"40","author":"Etxabe","year":"1994","journal-title":"Clin Endocrinol (Oxf)"},{"key":"R4-20251205","first-page":"3662","article-title":"Anticoagulant prophylaxis markedly reduces thromboembolic complications in Cushing's syndrome","volume":"87","author":"Boscaro","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"R5-20251205","first-page":"117","article-title":"Incidence and late prognosis of Cushing's syndrome: A population-based study","volume":"86","author":"Lindholm","year":"2001","journal-title":"J Clin Endocrinol Metab"},{"key":"R6-20251205","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.1210\/jc.2004-0079","article-title":"Hyperhomocysteinemia in patients with Cushing's syndrome","volume":"89","author":"Terzolo","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"R7-20251205","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1001\/jama.1997.03540460039030","article-title":"Plasma homocysteine as a risk factor for vascular disease. 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