Hyponatraemia and hypernatraemia: Disorders of Water Balance in Neurosurgery

Castle-Kirszbaum, Mendel; Kyi, Mervyn; Wright, Cassandra J. C.; Goldschlager, Tony; Danks, R. Andrew; Parkin, W. G.

doi:10.1007/s10143-020-01450-9

Cited by 24 publications

(28 citation statements)

References 138 publications

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“…They represent the range of manifestation of one disease (disturbances in ADH secretion following manipulation of the neurohypophysis) ( 29 ). According to the degree of damage, postoperative patients may exhibit fluctuations in ADH secretion termed “biphasic” and “triphasic” response, and syndrome of inappropriate antidiuretic hormone secretion (SIADH) likely represents an “isolated second phase” of the triphasic response ( 3 , 27 , 30 ). In this study, there were 25 and 65 patients who had combined DI-delayed hyponatremia and isolated delayed hyponatremia in the training cohort, respectively.…”

Section: Discussionmentioning

confidence: 99%

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Lin

Zeng²,

et al. 2022

Front. Endocrinol.

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ObjectiveThis study aimed to develop a nomogram of clinical variables and magnetic resonance imaging scans to predict delayed hyponatremia after transsphenoidal surgery for pituitary adenoma.MethodsPatients who underwent transsphenoidal surgery for pituitary adenoma in Fuzong Clinical Medical College of Fujian Medical University between January 2012 and December 2020 were retrospectively investigated. Medical records, MRI findings, and laboratory examination results were recorded as candidate variable predictors of delayed hyponatremia. A nomogram to predict delayed hyponatremia was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of the nomogram were assessed using the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analyses. The model underwent prospective validation in three medical centers with patients who underwent transsphenoidal surgery for pituitary adenoma between January 2021 and February 2022.ResultsThe model that incorporated the postoperative length of “measurable pituitary stalk,” pituitary stalk deviation angle difference, postoperative diabetes insipidus, sinking depth of diaphragma sellae, and blood sodium level on the second postoperative day was developed and presented as the nomogram of the training cohort. The nomogram achieved area under the ROC curve (AUCs) of 0.806 and 0.849 for the training cohort and the testing cohort, respectively, and displayed good calibration. Decision curve analysis showed that the nomogram was clinically useful when the threshold probability was 13–96%.ConclusionsWe developed a nomogram to evaluate the individualized prediction of delayed hyponatremia after transsphenoidal surgery for pituitary adenomas.

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Section: Discussionmentioning

confidence: 99%

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Lin

Zeng²,

et al. 2022

Front. Endocrinol.

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“…Patients with pituitary or diencephalon surgery often develop alterations of water homeostasis with polyuria and electrolyte disturbances, such as hyper- or hyponatremia, which should be promptly identified in order to avoid neurological sequelae [ 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Peri and Post-surgery Endocrine Complications And Their Mana...mentioning

confidence: 99%

Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy

2022

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Introduction: Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic–pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic–pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents. Conclusion: Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.

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“…Nonetheless, tolvaptan has recently shown beneficial effects in patients with SIADH after subarachnoid hemorrhage [ 15 ]. Current guidelines recommend tolvaptan as an escape-medication in resistant hyponatremia without hypovolemia [ 16 ▪▪ ]. It must be stressed that SIADH has many causes other than intracranial pathology, as Fig.…”

Section: Electrolyte and Fluid Disturbances In Perioperative Neuroane...mentioning

confidence: 99%

“…It must be stressed that SIADH has many causes other than intracranial pathology, as Fig. 1 summarizes [ 16 ▪▪ ].…”

Section: Electrolyte and Fluid Disturbances In Perioperative Neuroane...mentioning

confidence: 99%

“…AVP, arginine vasopressin (antidiuretic hormone); CVST, cerebral venous sinus thrombosis; GIT, gastrointestinal tract; GUT, genitourinary tract; MAOIs, monoamine oxidase inhibitors; MDMA, 3,4-methylenedioxy-methamphetamine; SAH, subarachnoid hemorrhage; SCLC, small cell lung carcinoma; SDH, subdural hematoma; SIAD, syndrome of inappropriate antidiuresis; SNRI, serotonin noradrenaline reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TBI, traumatic brain injury; TCA, tricyclic antidepressant. Reproduced with permission [ 16 ▪▪ ].…”

Section: Electrolyte and Fluid Disturbances In Perioperative Neuroane...mentioning

confidence: 99%

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Hyperlactatemia and other perioperative metabolic disturbances in neuroanesthesia

Klimek

Smalen

Janssen

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe concept of 'brain-body cross-talking' has gained growing interest in the last years. The understanding of the metabolic disturbances (e.g., hypernatraemia/hyponatraemia and hyperlactatemia) in neurosurgical patients has improved during the last years. Recent findingsThe impact of elevated lactate without acidosis in neurosurgical patients remains controversial. The pathophysiology of inappropriate secretion of antidiuretic hormone (SIADH) has become clearer, whereas the diagnosis of cerebral salt wasting should be used more carefully.

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Hyponatraemia and hypernatraemia: Disorders of Water Balance in Neurosurgery

Cited by 24 publications

References 138 publications

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy

Hyperlactatemia and other perioperative metabolic disturbances in neuroanesthesia

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