Post-operative diabetes insipidus after endoscopic transsphenoidal surgery

Abstract

Diabetes insipidus (DI) after endoscopic transsphenoidal surgery (ETSS) can lead to increased morbidity, longer hospital stays, and increased medication requirements. Predicting which patients are at high risk for developing DI can help direct services to ensure adequate care and follow-up. The objective of this study was to review our institution's experience with ETSS and determine which clinical/laboratory variables are associated with DI in this patient population. The authors wanted to see if there was an easily determined single value that would help predict which patients develop DI. This represents the largest North American series of this type. We retrospectively reviewed the charts of patients who had undergone ETSS for resection of sellar and parasellar pathology between 2006 and 2011. We examined patient and tumor characteristics and their relationship to postoperative DI. Out of 172 endoscopic transsphenoidal surgeries, there were 15 cases of transient DI (8.7%) and 14 cases of permanent DI (8.1%). Statistically significant predictors of postoperative DI (p < 0.05) included tumor volume and histopathology (Rathke's cleft cyst and craniopharyngioma). Significant indicators of development of DI were postoperative serum sodium, preoperative to postoperative change in sodium level, and urine output prior to administration of 1-deamino-8-D-arginine vasopressin. An increase in serum sodium of ≥2.5 mmol/L is a positive marker of development of DI with 80% specificity, and a postoperative serum sodium of ≥145 mmol/L is a positive indicator with 98% specificity. Identifying perioperative risk factors and objective indicators of DI after ETSS will help physicians care for patients postoperatively. In this large series, we demonstrated that there were multiple perioperative risk factors for the development of DI. These findings, which are consistent with other reports from microscopic surgical series, will help identify patients at risk for diabetes insipidus, aid in planning treatment algorithms, and increase vigilance in high risk patients.

ICAR: endoscopic skull‐base surgery

“…Most irregularities are transient, presenting within 1 to 14 days after surgery and typically resolving during this same time period. Diagnosis of such electrolyte imbalances requires a high degree of suspicion as well as close clinical and laboratory follow‐up, to prevent potentially catastrophic complications …”

“…Transient DI typically presents within 24 to 48 hours after surgery with polyuria and generally resolves around postoperative days 3 to 5. Several large endoscopic series report the incidence of transient DI ranging from 4.6% to 8.7% . Furthermore, recent studies comparing endoscopic and microscopic transsphenoidal adenoma resection indicate a decreased incidence of DI in patients undergoing endoscopic resection of pituitary adenomas (4.6% vs 38.5%) .…”

In-Hospital Postoperative Complications in Patients With Pituitary Adenoma Who Underwent Pituitary Surgery From January 2010 to December 2015: A Multicenter Study

“…The suggested risk factors that predispose to postoperative complications after pituitary surgery are tumor volume and histopathology, advanced age, body mass index, repeat operation, and previous radiotherapy [10,32,33]. In this study, the only identified risk factor for the onset of any postoperative complication was larger tumor size, specifically the width of the tumor.…”

Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

“…CDI belong to the polyuric-polydipsic syndrome, a group of disorders characterized by hypotonic polyuria mostly associated with compensatory polydipsia. CDI acquired forms are often surgical complication of pituitary surgery (18.3-31%) responsible for electrolyte disturbances and elevated morbidity in neurosurgical patients [3]; endoscopic minimally invasive technique has been associated with a lower rate of post-surgical CDI [4][5][6][7][8]. A transient AVP deficiency, due to dysfunction of the magnocellular hypothalamic neurons, is the most common pattern of presentation of CDI following surgical manipulation.…”

“…Although several risk factors have been identified for developing postoperative CDI (i.e., craniopharyngioma, Rathke's cleft cyst, maximal tumour diameter, intraoperative cerebrospinal fluid leak, visual abnormalities, young age, male sex), this disorder lacks widely agreed diagnostic criteria [3][4][5][6][7][8][9][10]. Because AVP plays a key role in the hydro-electrolytic regulation and in the pathophysiology of CDI, direct measurement of this neurohormone in the postoperative could contribute decisively to the early diagnosis.…”