Inappropriate Secretion of Antidiuretic Hormone after Transsphenoidal Surgery for Pituitary Tumors

Cusick, Joseph F.; Hagen, Thad C.; Kindling, James W.

doi:10.1056/nejm198407053110107

Cited by 76 publications

(55 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Following transphenoidal surgery DI and SIADH may cause morbidity due to fluid and electrolyte imbalance and in particular disturbance of sodium homeostasis (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). While most changes are mild, symptoms can occur if the serum sodium level falls below 130 mmol/L or above 149 mmol/L.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Staiger¹,

Sarnthein

Wiesli

et al. 2012

British Journal of Neurosurgery

View full text Add to dashboard Cite

Objective. Surgical manipulation of the pituitary stalk, neurohypophysis or the hypothalamus may disturb control of the plasma sodium level. The factors that might predict the risk of postoperative sodium imbalance are not clear, and were investigated in this study. Methods. A retrospective survey of 129 surgical records for the occurrence of plasma sodium levels outside the normal range, following transsphenoidal procedures. Median patient age was 49 (range 20-78) years, 65 female. 73 of the operated lesions were non-functioning pituitary adenomas. Patients were considered to have impaired plasma sodium balance if the range of 135-145 mmol/L was not maintained. Results. Of all 129 surgical cases, 68 (53%) experienced an imbalance in sodium levels. Severe sodium imbalance ( 149 or 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6). Tumour size was associated with an increased incidence of sodium imbalance, particularly in patients younger than 49 years; surgery resulted in sodium imbalance in 38% of young patients operated on for tumours < 22 mm and in 76% of young patients, operated on for tumours 22 mm. Overall, tumour size increased with patients' age, and tumour size was less predictive for sodium disturbances in elderly patients. Median time in hospital was 5 days for patients without sodium imbalance, 6 days for patients with hypernatraemia and 11 days for patients with hyponatraemia. Conclusions. Following pituitary surgery, patients with large tumours, in particular those of young age, are at higher risk for losing control of their plasma sodium level. Increased ADH secretion (hyponatraemia), but not transient diabetes insipidus was associated with a prolonged hospital stay. Postoperative follow-up of patients with sellar tumours should include careful monitoring of plasma sodium levels within the first two postoperative weeks and clear patients' instructions. Results: Of all 129 surgical cases, 68 (53%) experienced an imbalance in sodium levels. Severe sodium imbalance (≥149 or ≤ 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6).Tumour size was associated with an increased incidence of sodium imbalance, particularly in patients younger than 49 years; surgery resulted in sodium imbalance in 38% of young patients operated on for tumours < 22 mm and in 76% of young patients, operated on for tumours ≥ 22 mm. Overall, tumour size increased with patients' age, and tumour size was less predictive for sodium disturbances in elderly patients. Median time in hospital was 5 days for patients without sodium imbalance, 6 days for patients with hypernatraemia and 11 days for patients with hyponatraemia. Conclusions:Following pituitary surgery, patients with large tumours, in particular those of young age, are at higher risk for loosing control of their plasma sodium level.Increased ADH secretion (hyponatraemia), but not transient diabetes insipidus was a...

show abstract

Section: Introductionmentioning

confidence: 99%

“…Severe sodium imbalance (≥149 or ≤ 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6).…”

mentioning

confidence: 99%

Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Staiger¹,

Sarnthein

Wiesli

et al. 2012

British Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…38 Patients usually become hyponatremic approximately 5 days following surgery with the nadir and symptoms occurring a mean of 7 to 8 days postoperatively. 19,38,52,65,74 The common clinical manifestations are nausea, vomiting, headache, malaise, and dizziness. The lack of clinical predictors for the development of this delayed hyponatremia, other than a large tumor size (macroadenomas), suggests that tumor removal is responsible for a transient hypothalamopituitary disturbance.…”

mentioning

confidence: 99%

“…38 The release of ADH stores from those surgically manipulated neurohypophysial cells is the likely mechanism resulting in an SIADH-like syndrome with fluid retention and natriuresis. 38 Elevated serum levels of ADH have been demonstrated in patients in whom hyponatremia develops following transsphenoidal surgery for pituitary adenomas; 19,67 however, this is not always the case. 63 Many studies support the concept that delayed hyponatremia following transsphenoidal surgery is based on an adrenocortical insufficiency.…”

mentioning

confidence: 99%

Hyponatremia in the neurosurgical patient: diagnosis and management

Cole¹,

Gottfried²,

Liu³

et al. 2004

FOC

View full text Add to dashboard Cite

Hyponatremia is frequently encountered in patients who have undergone neurosurgery for intracranial processes. Making an accurate diagnosis between the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. The SIADH is a volume-expanded condition, whereas CSW is a volume-contracted state that involves renal loss of sodium. Treatment for patients with SIADH is fluid restriction and treatment for patients with CSW is generally salt and water replacement. In this review, the authors discuss the differential diagnosis of hyponatremia, distinguish SIADH from CSW, and highlight the diagnosis and management of hyponatremia, which is commonly encountered in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors, and postoperative cranial vault reconstruction for craniosynostosis.

show abstract

“…Hyponatremia in this setting can be due to overzealous ADH administration (via DDAVP medication), a coinciding SIADH secretion caused by operative trauma, 2,12,13,16 or CSW, which is a state characterized by hypovolemia and poor resorption of sodium in the kidney. A prior report regarding pituitary surgery found that combined DI and hyponatremia proceeded with hypernatremia on the 1st-3rd postoperative days followed by hyponatremia during postoperative Days 7.5-10.…”

Section: Discussionmentioning

confidence: 99%

Syndrome of alternating hypernatremia and hyponatremia after hypothalamic hamartoma surgery

Abla

Wait

Forbes

et al. 2011

FOC

View full text Add to dashboard Cite

Object In this paper, the authors' goal was to describe the occurrence of alternating hypernatremia and hyponatremia in pediatric patients who underwent resection of hypothalamic hamartomas (HHs) for epilepsy. Hypernatremia in patients after pituitary or hypothalamic surgery can be caused by diabetes insipidus (DI), whereas hyponatremia can occur due to a syndrome of inappropriate antidiuretic hormone, cerebral salt wasting, or excessive administration of desmopressin (DDAVP). The triphasic response after surgery in the pituitary region can also explain variations in sodium parameters in such cases. Methods One hundred fifty-three patients with HH who underwent surgery were enrolled in a prospective study to monitor outcomes. Of these, 4 patients (2.6%) were noted to experience dramatic alterations in serum sodium values. The medical records of these patients were identified and evaluated. Results Patients' ages at surgery ranged from 1.2 to 6.0 years. All patients were girls. Two patients had Delalande Type IV lesions (of 16 total Type IV lesions surgically treated) and 2 had Type III lesions (of 39 total Type III lesions). All patients had a history of gelastic seizures refractory to medication. Seizure frequency ranged from 3 to 300 per day. After surgery, all patients experienced hypernatremia and hyponatremia. The largest fluctuation in serum sodium concentration during hospitalization in a single patient was 53 mEq/L (range 123–176 mEq/L). The mean absolute difference in maximum and minimum sodium values was 38.2 mEq/L. All patients exhibited an initial period of immediate DI (independent of treatment) after surgery followed by a period of hyponatremia (independent of treatment), with a minimum value occurring between postoperative Days 5 and 8. All patients then returned to a hypernatremic state of DI, and 3 patients still require DDAVP for DI management. A second occurrence of hyponatremia lasting several days without DDAVP administration occurred in 2 patients during their hospitalization between periods of hypernatremia. One patient stabilized in the normal range of sodium values prior to discharge from rehabilitation without the need for further intervention. At last follow-up, 3 patients are seizure-free. Conclusions Severe instability of sodium homeostasis with hypernatremia and hyponatremia is seen in up to 2.6% of children undergoing open resection of HH. This risk appears to be related to HH type, with a higher risk for Types III (2 [5.1%] of 39) and IV (2 [12.5%] of 16) lesions. Here, the authors describe alternating episodes of hypernatremia and hyponatremia in the postoperative period following HH surgery. Management of this entity requires careful serial assessment of volume status and urine concentration and will often require alternating salt replacement therapy with DDAVP administration.

show abstract

Inappropriate Secretion of Antidiuretic Hormone after Transsphenoidal Surgery for Pituitary Tumors

Cited by 76 publications

References 6 publications

Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Hyponatremia in the neurosurgical patient: diagnosis and management

Syndrome of alternating hypernatremia and hyponatremia after hypothalamic hamartoma surgery

Contact Info

Product

Resources

About