Sufentanil-Induced Generalized Tonic–Clonic Seizure in a Patient with Pituitary Macroadenoma and Hypopituitarism: A Case Report
DOI:
https://doi.org/10.66166/cjaim.2.1.6Keywords:
Sufentanil, Generalized tonic–clonic seizure, Hypopituitarism, Pituitary macroadenoma, Adrenal insufficiency, Anesthesia inductionAbstract
Background: Opioid-induced convulsive episodes are exceedingly rare during anesthesia induction. When they occur, they typically manifest within seconds of intravenous opioid administration as generalized tonic–clonic movements without epileptiform EEG activity, suggesting a pharmacodynamic origin.
Case: We present a 67-year-old male with a pituitary macroadenoma and
panhypopituitarism who experienced a generalized tonic–clonic seizure immediately after receiving 20 μg of sufentanil during anesthesia induction. The seizure lasted ~30 seconds, accompanied by a blood pressure spike to 220/110 mmHg and oxygen desaturation to 65%. It resolved spontaneously with supportive care. Surgery was postponed, and the patient was monitored in intensive care; later that day, neurological examination and EEG showed no acute abnormalities.
Conclusions: Even small doses of sufentanil may precipitate seizures in susceptible patients. Endocrine disturbances (such as cortisol deficiency) can lower the seizure threshold by impairing neurosteroid-mediated GABAergic inhibition. This case underscores the importance of optimizing endocrine function and cautiously titrating opioids in vulnerable
individuals to mitigate the risk of peri-induction seizures.
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Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request. This work is intended for publication in the Croatian Journal of Anaesthesiology and Intensive Medicine.
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Copyright (c) 2026 Ana Piršljin, DInko Tonković, Vasilije Stambolija (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
