Hypothalamus-Pituitary Dysfunction as an Independent Risk Factor for Postoperative Central Nervous System Infections in Patients With Sellar Region Tumors

Abstract

ObjectiveThe purpose of this study was to verify that hypothalamus-pituitary dysfunction is one of the risk factors for postoperative central nervous system infections (PCNSIs).MethodWe performed a retrospective analysis of all patients with sellar region lesions who underwent surgery between January 2016 and November 2019 at Peking Union Medical College Hospital. In total, 44 age− and sex-matched controls were enrolled. Univariate and multivariate analyses were performed to identify risk factors for PCNSIs.ResultWe enrolled 88 patients, 44 of whom had PCNSIs. Surgical approach (TCS) (P<0.001), previous surgery on the same site (P=0.001), intraoperative cerebral spinal fluid (CSF) leakage (P<0.001), postoperative adrenal insufficiency (P=0.017), postoperative DI (P=0.004) and the maximum Na+ levels(<0.001) correlated significantly with PCNSIs. Multivariate analysis showed that Surgery approach (TCS)(OR: 77.588; 95%CI: 7.981-754.263; P<0.001), intraoperative CSF leakage (OR: 12.906; 95%CI: 3.499-47.602; P<0.001), postoperative DI (OR: 6.999; 95%CI:1.371-35.723; P=0.019) and postoperative adrenal insufficiency (OR: 6.115; 95%CI: 1.025-36.469; P=0.047) were independent influencing factors for PCNSIs.ConclusionTCS, intraoperative CSF leakage, postoperative DI and postoperative adrenal insufficiency are risk factors for PCNSIs in patients with sellar region tumors.

Infections and gender: clues for diagnosis of adrenal insufficiency—a case report and a review of the literature

“…The case of our patient, together with others [14][15][16][18][19][20], suggests that the high frequency of infectious events may not be exclusively iatrogenic but also a direct consequence of the underlying disease. The increased use of antimicrobial agent even before the steroid therapy [16] and the presence of infection events as a co-diagnosis at the first diagnosis of the disease [17] strengthen our hypothesis.…”

“…The involvement of this latter tract can be insidious as abdominal symptoms overlap adrenal crisis. Furthermore, it was shown that adrenal insufficiency is an independent risk factor for the development of central nervous system infections following neurosurgical removal of sella turcica tumours [18].…”

“…The patients affected by adrenal insufficiency use more antibiotics than control before and after the diagnosis Smans et al [15] 2013 Retrospective cohort study 390 Patients with primary adrenal insufficiency had an increased use of antimicrobial agents and hospital admissions related to infection Isidori et al [20] 2018 A single-blind, randomized controlled trial 89 Restoration of a more physiological circadian glucocorticoid rhythm by switching to a once-daily, modified-release regimen reduces recurrent infections Chantzichristos et al [7] 2017 Retrospective cohort study 226 Mortality is higher from infections and unknown cause that may be explained by untreated or inadequately treated adrenal crisis, severe hypoglycaemia or their combination Bancos et al [19] 2017 Cross-sectional study 42 Adrenal insufficiency is associated with significantly decreased natural killer cell cytotoxicity Tresoldi et al [13] 2020 Retrospective cohort study 2182 There is an increased risk of infections and antimicrobial use in PAI in the primary care setting at least partially linked to glucocorticoid treatment Ngaosuwan et al [6] 2021 Retrospective cohort study 6821 Mortality was increased in adrenal insufficiency. Cardiovascular disease and infections were the most frequent causes of death Wen et al [18] 2021 Retrospective study 11 Postoperative adrenal insufficiency is a risk factors for postoperative central nervous system infections in patients with sellar region tumours Minnetti et al [14] 2022 Prospective observational study 135 The disruption of endogenous GC levels, irrespective of the underlying cause, is associated with increased susceptibility to infections between males and females. Thus, especially in female, empty sella syndrome should be counted in the possible causes of secondary adrenal insufficiency.…”

Case report: A rare case of thyrotropin-secreting pituitary macroadenoma with diffuse calcification presenting with hyperthyroidism and literature review

“…The sellar region, one of the most complex neoplastic areas of the brain, can give rise to a wide variety of pathologically distinct tumors, including pituitary adenoma, germ cell tumor, Rathke’s cleft cyst, meningioma, chordoma, craniopharyngioma, etc. ( 18 ). Most of these tumors, especially craniopharyngiomas, are often accompanied by calcification; however, pituitary adenomas with calcification are scarcely rare ( 19 ).…”

Early Identification of Correlated Risk Factors can Improve the Prognosis of Patients with Postoperative Intracranial Infection

“…The incidence of intracranial infection after neurosurgery can vary from 0.7 to 8.9%, as reported in different studies. [1][2][3][4] This discrepancy may derive from the choice of different diagnostic criteria, the presence of multiple clinical factors that may interfere with the prognosis, and regional differences. China has the largest population in the world, and the highest number of craniotomies is performed in China.…”