This case report describes a 73-year-old female with previously undiagnosed acromegaly who presented for a planned robotic supracervical hysterectomy. Preoperative recognition of acromegaly had not been made. During the index operation the patient developed pronounced hemodynamic intolerance during prolonged abdominal insufflation, which led to intraoperative reassessment.
The anesthetic team identified a severely depressed ejection fraction (EF) during the event. The observed EF was 10% to 15%, indicating marked left ventricular systolic dysfunction. Given the severity of the cardiac depression and the intolerance to pneumoperitoneum, the surgical procedure was aborted and the patient was redirected to medical evaluation and treatment for her underlying conditions.
The principal intraoperative problem was poor tolerance of prolonged abdominal insufflation for robotic laparoscopy. The insufflation period revealed significant cardiovascular compromise related to markedly reduced cardiac systolic function. The depressed EF was measured intraoperatively and was the proximate cause for aborting the hysterectomy.
The case illustrates how pneumoperitoneum and the physiologic effects of laparoscopic surgery can unmask or exacerbate underlying cardiac dysfunction. In this patient the circulatory response was sufficiently severe to prevent completion of the planned procedure and to necessitate urgent cardiac-focused management.
After the aborted operation the patient underwent evaluation that established a diagnosis of acromegaly associated with cardiomyopathy and heart failure. The abstract reports that the patient was treated for both acromegaly and heart failure, but specific pharmacologic agents, dosing regimens, or procedural interventions (for example definitive pituitary therapy) are not detailed in the source abstract.
The report notes that the patient received medical therapy aimed at the endocrine disorder and the cardiac dysfunction. The precise timeline and components of medical management were not specified in the abstract; only that treatment was instituted and that follow-up assessment was performed.
Fifteen months after initiating treatment for acromegaly and heart failure, the patient demonstrated marked improvement in left ventricular function. Her EF recovered from 10%–15% to 50%–55%. This degree of recovery reflects substantial reversal of systolic dysfunction over the follow-up interval reported in the case.
With the improved cardiac status, the patient subsequently underwent pelvic organ prolapse repair without reported perioperative complications. The successful second procedure underscores that medically optimizing the underlying endocrine and cardiac conditions allowed the patient to tolerate subsequent surgery safely.
This case emphasizes several perioperative considerations:
Undiagnosed acromegaly may be associated with progressive cardiomyopathy and frank heart failure that can remain clinically occult until stressed by perioperative physiologic challenges such as pneumoperitoneum.
Markedly reduced ejection fraction can lead to intolerance of laparoscopic insufflation and hemodynamic instability severe enough to require aborting a planned operation.
When clinical suspicion for acromegaly exists preoperatively, early diagnosis and initiation of medical therapy may permit optimization of cardiovascular function before elective surgery. The authors state that such optimization may reduce risks of perioperative instability. The abstract does not provide a detailed protocol for screening, medical agents used, or timing of definitive endocrine therapy.
Careful preoperative cardiovascular evaluation is indicated in patients with features suggestive of acromegaly or other conditions known to cause cardiomyopathy. The case supports a strategy of medical stabilization and reassessment of cardiac function prior to elective procedures, particularly those involving pneumoperitoneum or other significant physiologic stressors.
The authors declared no conflicts of interest in the original report. The abstract lists literature cited in the full article, including an Endocrine Society clinical practice guideline on acromegaly and several reviews on acromegalic cardiomyopathy and perioperative cardiovascular consequences of laparoscopic surgery. Full reference details appear in the source publication. The abstract reports the patient outcome and follow-up interval (15 months) but does not list specific medications or interventions used in treatment.