Anesthetic Implications of Hyperhomocysteinemia in Neurosurgical Practice: A Case-Based Narrative

Hyperhomocysteinemia (HHC) is related to a metabolic disorder homocystinuria, which is associated with cysta-thionine β ‐ synthase de fi ciency. Homocysteine accumulation is associated with disorders of various systems and is a risk factor for stroke, thromboembolism, and coronary artery disease. 1 We describe the anesthetic management of HHC patient for neurosurgery, which is not previously described. Written informed consent was obtained. A 25-year-old lady weighing 81kg (body mass index: 31.24kg/m 2 ) with HHC presented with weight gain, menstrual irregularities, headache, and blurring of vision (since 6 months). She had features of Cushing ’ s disease like short neck, cervicodorsal pad of fat, moon-like facies, truncal obesity with Mallampatti grade 3, upper lip bite test-2, thyromental distance > 6.5 cm, controlled diabetes mellitus, hypertension, and hypothyroidism. Her serum cortisol level was 24.20 µg/dl (normal 2.3 – 11.9 µg/dL), adrenocorticotropic hormone 67.54 pg/mL (normal 7 – 63 pg/mL), and 1.2 (cid:1) 1.5 (cid:1) 1.3 cm pituitary tumor on magnetic