Endocrine Function and Water Metabolism in Children and Adolescents with Surgically Treated Intra/Parasellar Tumors

Abstract

Hydroelectrolytic disorders often complicate surgery of intra/parasellar tumors in children and adolescents. Eighteen patients undergoing microneurosurgical procedures for intra-supra-sellar craniopharyngioma (10 patients), hypothalamic germinomas (3 patients), hypothalamic-chiasmatic astrocytomas (3 patients), pituitary adenomas (2 patients) were studied. The hydroelectrolytic balance was assessed from 8 hours before surgery to 1 week after with a specific protocol in which water metabolism alterations were treated with standard procedure. Diabetes insipidus (DI) was observed in 10/18 patients before surgery and in 15/18 patients after surgery; during surgery it was effectively treated with synthetic desmopressin (DDAVP) and hydroelectrolytic solutions. Hyponatremia, isolated or associated (with diuresis contraction or polyuria), seen during surgery and in the following 24 hours, was treated with variation of the infusion rate. We show that close monitoring and treatment of hydroelectrolytic disorders in patients submitted to neurosurgery for intra/ parasellar tumors may significantly reduce their morbidity and mortality rate.

Water and Electrolyte Disorders at Long-Term Post-Treatment Follow-Up in Paediatric Patients with Suprasellar Tumours Include Unexpected Persistent Cerebral Salt-Wasting Syndrome

“…The posttreatment DI incidence was also higher in our cohort (50.3%) than in brain tumour survivors overall (around 13%) [5]. Postsurgery DI was high in craniopharyngiomas (79.7%) and germinomas (77.8%), comparable to what has been described in the literature (76-96%) [10,17,18,19,20], and slightly higher than expected in gliomas (14.5%).…”

“…Reassessment during follow-up would also be compulsory, especially during surgery and chemotherapy [4,9,10,11,12,13,14,15,17,19,24], after the end of treatment, or if WED is suspected (polyuria, polydipsia, or the development of signs or symptoms suggesting hypo- or hypernatraemia).…”

“…Most studies in populations with brain tumours include all tumour types and localizations, so cohorts exclusively constituted of patients with sellar and suprasellar tumours are rare [11,17]. An exception to this rule are craniopharyngiomas, which are a very well-studied subgroup [10,18,19,20].…”

Management of Electrolyte and Fluid Disorders after Brain Surgery for Pituitary/Suprasellar Tumours

“…Other tumours are functioning and non-functioning pituitary adenomas, germinomas and non-germinomatous germ cell tumours, Langerhans cell histiocytoses, chiasmatic (low-grade) gliomas, suprasellar arachnoid cysts and hypothalamic-pituitary astrocytomas [1]. These tumours present with acute or more insidious compression symptoms of adjacent neural structures leading to a raised intracranial pressure with hydrocephalus in 50%, visual impairment in 38% and endocrine abnormalities in 66-77% of cases [1,2], with a higher incidence in craniopharyngiomas than in the other tumour types [2,3,4,5]. Although symptoms due to neuroendocrine dysfunction may not be obvious at presentation [6], clinical features of endocrinopathies are frequently found on careful assessment and have often been present for months or years prior to presentation.…”

“…CDI is a common postoperative complication that occurs in 83% of patients with intrasellar and parasellar tumours [2], especially in those with large tumours damaging the ADH-secreting neurons and radical surgical excision with pituitary stalk resection. Other factors found to be associated with an increased risk of developing postoperative CDI are a young age, male gender, CSF leak, and resection of certain types of lesions including craniopharyngiomas, Rathke's cleft cysts and ACTH-secreting pituitary adenomas [22,23,24].…”