Clinical aspects of endocrinology: parathyroid and adrenal gland disorders

The parathyroid glands are responsible for calcium homoeostasis, which is necessary for appropriate functioning of the musculoskeletal and nervous systems. Parathyroid adenoma remains the most common indication for surgery. Anaesthetic considerations for parathyroid surgery include good hydration, appropriate positioning, monitoring renal function along with serum electrolytes. The adrenal cortex is mainly responsible for secretion of mineralocorticoids, glucocorticoids, and androgens whereas the medulla consists of pre-ganglionic sympathetic ganglion, which secretes epinephrine, nor-epinephrine and dopamine. Adrenocortical disease results in disturbance of water balance, electrolytes, cardiovascular instability and metabolic disturbances. Correction of water, electrolyte imbalance, blood pressure control with invasive monitoring, appropriate positioning, analgesia with appropriate hormone replacement therapy form the key principles of the anaesthetic management.