Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas

Hensen, J.; Henig, Anja; Fahlbusch, Rudolf; Meyer, Martin; Boehnert, Markus; Buchfelder, Michael

doi:10.1046/j.1365-2265.1999.00666.x

Cited by 248 publications

(208 citation statements)

References 44 publications

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“…Therefore, it should be kept in mind that the cortisol level measured on the 2nd or 3rd postoperative day might not reflect, and may be higher than that at 1 week. Patients with cortisol levels lower than 220-270 nmol/l (8-10 mg/dl) on the 2nd or 3rd postoperative day are discharged and recommended for low-dose glucocorticoid replacement therapy (26)(27)(28)(29). The results of this study are consistent with these practices.…”

Section: Discussionsupporting

confidence: 80%

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Karaca

Tanrıverdi²,

Atmaca³

et al. 2010

European Journal of Endocrinology

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Background: The aims of this study were to evaluate the validity of preoperative basal serum cortisol levels measured in predicting preoperative adrenal insufficiency and also the validity of basal serum cortisol levels and early postoperative insulin tolerance test (ITT) in predicting postoperative adrenal insufficiency. Methods: The study was prospectively designed and included 64 patients who underwent pituitary surgery for conditions other than Cushing's disease. An ITT was performed preoperatively, on the 6th postoperative day and at the 1st postoperative month. Basal serum cortisol levels were measured on the 2nd, 3rd, 4th, 5th, and 6th postoperative days. Results: Patients with a preoperative basal cortisol level of !165 nmol/l (6 mg/dl) showed insufficient cortisol response and those with levels higher than 500 nmol/l (18 mg/dl) had sufficient cortisol response to the preoperative ITT. The positive predictive value of the ITT performed on the 6th postoperative day was 69.7%, and the negative predictive value in predicting adrenal insufficiency at the 1st postoperative month was 58%. Patients were considered to have an insufficient cortisol response to ITT at the 1st postoperative month if their basal cortisol levels were !193 nmol/l (7 mg/dl) or 220 nmol/l (8 mg/dl) or 193 nmol/l (7 mg/dl) or 165 nmol/l (6 mg/dl) or 83 nmol/l (3 mg/dl) on the 2nd-6th postoperative days respectively. Conclusion: Serum basal cortisol levels may be used as the first-line test in the assessment of the hypothalamic-pituitary-adrenal axis both preoperatively and postoperatively. Dynamic testing should be limited to the patients with indeterminate basal cortisol levels.

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Section: Discussionsupporting

confidence: 80%

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Karaca

Tanrıverdi²,

Atmaca³

et al. 2010

European Journal of Endocrinology

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“…Post-operative hyponatremia occurred in 30.7% of patients from postoperative day 4 to 7. Previously reported risk factors influencing post-operative hyponatremia [1,3,4,[6][7][8][9] showed insignificant effects in this study. Emergence of hyponatremic symptoms depended on the severity of post-operative hyponatremia, and the degree of post-TSS serum Na reduction.…”

Section: Discussionmentioning

confidence: 67%

“…Predicting hyponatremia, especially symptomatic hyponatremia, is useful for providing pertinent care to these patients who may opt for a short post-operative length of hospital stay. In previous studies where the elderly age-bracket (mean: ≥ 50 years), female gender, pre-existing microadenoma, and/or presence of transient diabetes insipidus (DI) were adopted as the predicting factors for hyponatremia [1,3,4,[6][7][8][9], the results were however controversial. These previous papers defined the post-operative hyponatremia simply as post-operative low serum Na, not concerned with the serum Na decline after TSS.…”

mentioning

confidence: 99%

Post-operative hyponatremia in patients with pituitary adenoma: post-operative management with a uniform treatment protocol

et al. 2011

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Hyponatremia after transsphenoidal surgery (TSS) for pituitary tumors occurs in 1.8 to 35% of operated patients [1][2][3][4][5][6]. Predicting hyponatremia, especially symptomatic hyponatremia, is useful for providing pertinent care to these patients who may opt for a short post-operative length of hospital stay. In previous studies where the elderly age-bracket (mean: ≥ 50 years), female gender, pre-existing microadenoma, and/or presence of transient diabetes insipidus (DI) were adopted as the predicting factors for hyponatremia [1,3,4,[6][7][8][9], the results were however controversial. These previous papers defined the post-operative hyponatremia simply as post-operative low serum Na, not concerned with the serum Na decline after TSS. Department of Neurosurgery, Onomichi General Hospital, Japan abstract. This study is a retrospective analysis of hyponatremia after transsphenoidal surgery in patients with pituitary adenoma. We evaluated (i) the incidence of post-operative hyponatremia (serum Na levels ≤ 135 mEq/L) and the emergence of hyponatremic symptoms, and assessed (ii) the risk factors under a uniform protocol of i.v. infusion with steroid and electrolyte fluid. We examined 88 consecutive operated patients (female: 60; male: 28) with pituitary adenoma. Apart from reconfirming the effects of the purported risk factors, we focused on the degree of serum Na decline on post-operative hyponatremia. Although remained stable during early post-operative period (4 days after surgery), the serum Na levels subsequently decreased after post-operative day 4 in 81 of 88 cases (92.0%). Of 88 patients, 27 (30.7%) and 9 (10.2%) cases suffered from hyponatremia, and developed hyponatremic symptoms. Interestingly, the degree of serum Na levels decline (from pre-operative levels) indicated a useful independent risk factor for monitoring hyponatremic symptoms (p = 0.006) and the degree of decline tended to be greater in elder patients (> 60 years) (p = 0.0346). Serum Na levels should be monitored from, at least, post-operative day 7 to detect early development of hyponatremia. Special attention and recovery effort should be given to elder patients with marked serum Na level decline after surgery.

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“…16 The timing of the DPH after TSS has been generally consistent, occurring on PODs 4-7 and resolving within 2-3 weeks. 15,18,20,27,30,32,33 Factors associated with the development of DPH vary in previous reports and include age, 16,18,30 female sex 33 or estrogen use, 22 tumor size, 15,26,30 early diabetes insipidus after surgery, 33 Cushing disease, 14,24 and surgical trauma to the neurohypophysis. 22 Some of these factors were also identified in our univariate analyses, including female sex (p = 0.027).…”

Section: Discussionmentioning

confidence: 99%

Delayed postoperative hyponatremia after transsphenoidal surgery: prevalence and associated factors

Hussain

Piper

Ludlam

et al. 2013

JNS

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Object Transient delayed postoperative hyponatremia (DPH) after transsphenoidal surgery (TSS) is common and can have potentially devastating consequences. However, the true prevalence of transient symptomatic and asymptomatic DPH has not been studied in a large patient cohort with close and accurate follow-up. Methods A retrospective analysis of a single-institution prospective database was conducted; all patients undergoing TSS for lesions involving the pituitary gland were followed up in a multidisciplinary neuroendocrine clinic, and demographic, imaging, and clinical data were prospectively collected. Patients were examined preoperatively and followed up postoperatively in a standardized fashion, and their postoperative sodium levels were measured at Weeks 1 and 2 postoperatively. Levels of hyponatremia were rated as mild (serum sodium concentration 130–134 mEq/L), moderate (125–129 mEq/L), or severe (< 125 mEq/L). Routine clinical questionnaires were administered at all postoperative office visits. Postoperative hyponatremia was analyzed for correlations with demographic and clinical features and with immediate postoperative physiological characteristics. Results Over a 4-year interval, 373 procedures were performed in 339 patients who underwent TSS for sellar and parasellar lesions involving the pituitary gland. The mean (± SD) age of patients was 48 ± 18 years; 61.3% of the patients were female and 46.1% were obese (defined as a body mass index [BMI] ≥ 30). The overall prevalence of DPH within the first 30 days postoperatively was 15.0%; 7.2% of the patients had mild, 3.8% moderate, and 3.8% severe hyponatremia. The incidence of symptomatic hyponatremia requiring hospitalization was 6.4%. The Fisher exact test detected a statistically significant association of DPH with female sex (p = 0.027) and a low BMI (p = 0.001). Spearman rank correlation detected a statistically significant association between BMI and nadir serum sodium concentration (r = 0.158, p = 0.002) and an inverse association for age (r = −0.113, p = 0.031). Multivariate analyses revealed a positive correlation between postoperative hyponatremia and a low BMI and a trend toward association with age; there were no associations between other preoperative demographic or perioperative risk factors, including immediate postoperative alterations in serum sodium concentration. Patients were treated with standardized protocols for hyponatremia, and DPH was not associated with permanent morbidity or mortality. Conclusions Delayed postoperative hyponatremia was a common result of TSS; a low BMI was the only clear predictor of which patients will develop DPH. Alterations in immediate postoperative sodium levels did not predict DPH. Therefore, an appropriate index of suspicion and close postoperative monitoring of serum sodium concentration should be maintained for these patients, and an appropriate treatment should be undertaken when hyponatremia is identified.

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Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas

Cited by 248 publications

References 44 publications

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Post-operative hyponatremia in patients with pituitary adenoma: post-operative management with a uniform treatment protocol

Delayed postoperative hyponatremia after transsphenoidal surgery: prevalence and associated factors

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