Hyponatremia in the neurosurgical patient: diagnosis and management

Cole, Chad; Gottfried, Oren N.; Liu, James K.; Couldwell, William T.

doi:10.3171/foc.2004.16.4.10

Cited by 74 publications

(72 citation statements)

References 81 publications

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“…Natriuresis above 20-30 mEq/l in SIADH is explained by the increased glomerular filtration rate or by the decreased renal tubular sodium reabsorption induced by other hormones. As we have previously mentioned, when establishing a diagnosis, it is crucial to discard other causes of hyponatraemia which usually occur in patients undergoing neurosurgery (oedematous (9,10). Table 2 shows the diagnostic criteria of SIADH.…”

Section: Siadhmentioning

confidence: 99%

“…Secondary adrenal insufficiency may be the underlying cause of a SIADH-like condition, as cortisol has proved to be a potent inhibitor of vasopressin secretion (10).…”

Section: Siadhmentioning

confidence: 99%

“…Relevant clinical findings are hypotension, increased skin turgidity, sunken eyes, dry mucous membranes, lack of axillary sweating, tachycardia and orthostatic hypotension. In case of monitorised patients with pulmonary capillary pressure or central venous pressure, a low pulmonary capillary (!8 mmHg) or central venous pressure (!6 mmHg) suggest contracted extracellular volume (7,10,15).…”

Section: Differential Diagnosis Of Siadh and Cswsmentioning

confidence: 99%

“…However, elevated ADH levels are not the rule in these patients and levels similar to those observed in normonatremic patients can be detected. As a matter of fact, the measurement of plasma ADH is not considered among the parameters requested in order to formulate a diagnosis of SIADH (9,10).…”

Section: Siadhmentioning

confidence: 99%

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Early hyponatraemia after pituitary surgery: cerebral salt-wasting syndrome

Guerrero¹,

Pumar²,

Soto³

et al. 2007

eur j endocrinol

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Hyponatraemia is a common complication in patients undergoing neurosurgery. It can be caused either by the syndrome of inappropriate secretion of antidiuretic hormone or by the cerebral saltwasting syndrome (CSWS). CSWS frequently occurs in patients suffering from subarachnoid haemorrhage and brain injury, but it is rare after pituitary tumour surgery. However, this diagnostic possibility should be considered as these disorders require specific treatment and have different prognoses.In this article, we present a case of acute and early hyponatraemia caused by CSWS after pituitary tumour surgery. We also revise the aetiology, mechanisms, differential diagnosis and treatment of hyponatraemia after pituitary surgery. European Journal of Endocrinology 156 611-616 Case reportA 35-year-old woman presented with headaches and decreased visual acuity, which she had been experiencing for several months. She did not have any clinical manifestations of endocrine dysfunction and her baseline hormonal parameters were normal. The campimetry revealed minimum central vision in the superior nasal quadrant of the right eye and temporary hemianopsia in the left eye.Nuclear magnetic resonance revealed a tumour of 4 cm in the pituitary with a central cyst which compressed the optic chiasm and invaded the cavernous sinuses. The patient underwent transsphenoidal surgery and the tumour was partially resected. No postoperative complications occurred and postoperative hormonal parameters were normal (i.e. thyroid hormones, 24-h urinary free cortisol and basal plasma cortisol, gonadotrophins, oestradiol, prolactin, growth hormone (GH) and insulin-like growth factor I). The anatomopathological examination confirmed pituitary adenoma with focal follicle-stimulating hormone positivity.Ten months later, the patient underwent a new intervention due to the significant growth of tumoural rests. Hypotonic solution (i.e. infusate of 0.2% sodium chloride in 5% dextrose in water (1500 ml/day)) was administered in the first 48 h after surgery. Early baseline hormonal assessment did not show any deficit. The only postoperative complication was acute hyponatraemia with excessive natriuresis. At 48 h postsurgery, asymptomatic hyponatraemia (126 mEq/l, the normal range being 135-145 mEq/l) with serum osmolality of 264 mOsm/kg (normal range 275-300 mOsm/kg) and elevated natriuresis (urine sodium 215 mEq/l, diuresis 3250 ml/24 h and urinary osmolality 706 mOsm/kg) were detected. Twenty-four hours later, the patient presented with nausea and vomiting; natraemia had decreased to 116 mEq/l, and natriuresis levels remained elevated (118 mEq/l, diuresis 2100 ml/24 h). The examination showed dry mucous membranes and slightly decreased skin turgidity; arterial systolic pressure was between 110 and 100 and diastolic pressure between 60 and 70 mmHg. No other symptoms of volume depletion were found. The patient was administered 3% hypertonic saline solution (31 ml/h for 2 days and then 15 ml/h). Natraemia levels rose to 124 mEq/l in 24 h; at this point, the s...

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Section: Siadhmentioning

confidence: 99%

“…Secondary adrenal insufficiency may be the underlying cause of a SIADH-like condition, as cortisol has proved to be a potent inhibitor of vasopressin secretion (10).…”

Section: Siadhmentioning

confidence: 99%

Section: Differential Diagnosis Of Siadh and Cswsmentioning

confidence: 99%

Section: Siadhmentioning

confidence: 99%

See 2 more Smart Citations

Early hyponatraemia after pituitary surgery: cerebral salt-wasting syndrome

Guerrero¹,

Pumar²,

Soto³

et al. 2007

eur j endocrinol

View full text Add to dashboard Cite

show abstract

“…Hyponatremia is the most common electrolyte abnormality seen in critically ill patients [1]. Patients with polytrauma and traumatic brain injury are the most critically ill patients, and hyponatremia is frequently seen in these patients [2][3][4].…”

Section: Introductionmentioning

confidence: 99%