Predictors and Incidence of Central Diabetes Insipidus After Endoscopic Pituitary Surgery

Sigounas, Dimitri; Sharpless, Julie L.; Cheng, Danny; Johnson, Tiffany G.; Senior, Brent A.; Ewend, Matthew G.

doi:10.1227/01.neu.0000311063.10745.d8

Cited by 85 publications

(71 citation statements)

References 27 publications

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“…Frequently, there can be isolated transient hyponatremia (phase 2) following transphenoidal surgery, with spontaneous resolution [64][65][66]. Regardless of the pattern of presentation, in post-surgical patients with serum sodium ≤145 mEq/l spontaneous resolution is the rule [67]. In post-surgical patients with serum sodium >145 mEq/l, permanent CDI is likely [67].…”

Section: Central Diabetes Insipidus (Cdi)mentioning

confidence: 99%

“…Regardless of the pattern of presentation, in post-surgical patients with serum sodium ≤145 mEq/l spontaneous resolution is the rule [67]. In post-surgical patients with serum sodium >145 mEq/l, permanent CDI is likely [67]. In cases of post-traumatic CDI as opposed to postsurgical CDI, once polyuria has persisted for a few weeks, CDI is likely to be permanent [68].…”

Section: Central Diabetes Insipidus (Cdi)mentioning

confidence: 99%

See 1 more Smart Citation

Diabetes Insipidus: A Review

Shapiro¹

2013

J Diabetes Metab

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Section: Central Diabetes Insipidus (Cdi)mentioning

confidence: 99%

Section: Central Diabetes Insipidus (Cdi)mentioning

confidence: 99%

Diabetes Insipidus: A Review

Shapiro¹

2013

J Diabetes Metab

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“…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%

“…In case of inappropriate or uncontrolled ADH release (not stimulated by increased plasma osmolality or hypovolemia; but triggered by brain signals or caused by neuronal damage), serum sodium usually drops unless water supply is markedly restricted (5).. Symptoms of sodium imbalance include dizziness, headaches, paraesthesias, nausea, vomiting and lethargy, but can progress to altered mental status and seizures if severe hyponatraemia or hypernatraemia occur (3).…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Staiger¹,

Sarnthein

Wiesli

et al. 2012

British Journal of Neurosurgery

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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...

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“…Tri-phases of central diabetes insipidus after severe damage to the hypothalamus or supraopticohypophyseal tract There was rarely any statement or discussion associated with the factors implicated in the persistence and the duration of post-trauma DI. Although one study has discovered that postoperative hypernatremia (higher than 145 mmol/L) within the first five days has a high predictor value for permanent DI development (Sigounas, Sharpless et al 2008). Different phases of post-head injury were presented with various amounts of urine output clinically.…”

Section: Transient or Persistent Diabetes Insipidusmentioning

confidence: 99%