Predictors of Delayed Hyponatraemia After Surgery for Pituitary Tumour

Author:

Rajan Remya1ORCID,Chacko Ari George2,Verma Shivendra3,Kapoor Nitin1,Paul Thomas1,Thomas Nihal1,Jebasingh Felix1,Cherian Kripa Elizabeth1,Sahu Shalini4,Shyamasunder Asha Hesarghatta1

Affiliation:

1. Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India

2. Department of Neurosciences, Christian Medical College and Hospital Vellore, Vellore, India

3. Endocrinology, GSVM Superspeciality Post Graduate Institute, Kanpur, India

4. Radiology, Christian Medical College and Hospital Vellore, Vellore, India

Abstract

AbstractDelayed hyponatraemia(DH) is a common complication following trans-sphenoidal surgery(TSS) for pituitary tumour. We evaluated the prevalence of DH following TSS, and assessed the factors associated with DH, including early post-operative diabetes insipidus(EPDI). This retrospective study included 100 TSS for pituitary tumours in 98 patients, over a period of 26 months. Subjects were divided into two groups: those who developed hyponatraemia and those who did not develop hyponatraemia, during post-operative days 4 to 14. The clinical characteristics and peri-operative parameters were compared between the two groups, to identify factors predicting DH. The mean age of the patients was 42.0±13.6 years, 58 (59%) were females and 61 (61%) had functional tumours. Thirty-six patients(36%) developed DH following TSS of whom majority(58%) were diagnosed on post-operative days 7 and 8; only 8/36 (22%) were symptomatic. Syndrome of inappropriate antidiuretic hormone secretion(SIADH) was found to be the most common aetiology of DH. On logistic regression analysis, intra-operative cerebrospinal fluid(CSF) leak (OR 5.0; 95% CI 1.9–13.8; p=0.002), EPDI (OR 3.4; 95% CI 1.3–9.2; p=0.015) and peri-operative steroid use (OR 3.6; 95% CI 1.3–9.8; p=0.014) were found to be significantly associated with DH. In conclusion, EPDI, intra-operative CSF leak and peri-operative steroid use were significant predictors of DH. EPDI predicts moderate to severe hyponatraemia with 80% specificity but has low sensitivity(47%). As most patients have asymptomatic hyponatraemia, serum sodium measurement on POD 7 to 10 would be helpful to identify DH in patients at increased risk.

Publisher

Georg Thieme Verlag KG

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,General Medicine,Endocrinology, Diabetes and Metabolism

Reference23 articles.

1. Delayed hyponatremia following surgery for pituitary adenomas: an under-recognized complication;S Rajaratnam;Neurol India,2020

2. Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma;D F Kelly;Report of nine cases. J Neurosurg,1995

3. Pathophysiology of hyponatremia after transsphenoidal pituitary surgery;B R Olson;J Neurosurg,1997

4. Delayed hyponatremia following transsphenoidal surgery for pituitary adenoma;J I Lee;Neurol Med Chir (Tokyo),2008

5. Delayed postoperative hyponatremia after transsphenoidal surgery: prevalence and associated factors;N S Hussain;J Neurosurg,2013

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