Sodium and Water Imbalance After Sellar, Suprasellar, and Parasellar Surgery

Kiran, Zareen; Sheikh, Aisha; Momin, Sehrish Nizar Ali; Majeed, Isra; Awan, Safia; Rashid, Owais; Islam, Najmul

doi:10.4158/ep161616.or

Cited by 23 publications

(21 citation statements)

References 23 publications

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“…Patients undergoing neurosurgery are always prone to develop HN, especially in patients with craniopharyngioma, Rathke's cleft cyst, and Cushing disease. Previous studies have shown that HN occurred in 8.4–35% cases (Hussain et al, 2013; Kiran et al, 2017). Previous studies demonstrated that old age (>60 years), gender, and tumor size were identified as potential predictors of delayed symptomatic HN (Cote et al, 2016; Yoon et al, 2019); meanwhile, researchers reported that the incidence of delayed HN in patients with non-functioning pituitary tumor who underwent endoscopic transsphenoidal surgery was 22.6%.…”

Section: The Incidence and Clinical Characteristics Of Siadh And Cswsmentioning

confidence: 92%

“…Delayed HN usually develops on postoperative days 4–10 (Jahangiri et al, 2013; Yoon et al, 2019). Kiran et al (2017) reported that patients with HN caused by SIADH mostly occurred on days 7–14. CSWS was reported to be the most common cause of HN among pediatric patients following intracranial tumor surgery.…”

Section: The Incidence and Clinical Characteristics Of Siadh And Cswsmentioning

confidence: 99%

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Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Cui

Yang

et al. 2019

Front. Neurosci.

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The differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) in patients with neurological disorders has been a perplexing clinical controversy. The purpose of this review is to summarize the characteristics and risk factors of patients with different types of neurological disorders complicated by hyponatremia (HN) and review various methods to distinguish SIADH from CSWS. Common neurological disorders with high rates of HN include subarachnoid hemorrhage (SAH), traumatic brain injuries, stroke, cerebral tumors, central nervous system (CNS) infections, and Guillain-Barré syndrome (GBS), which have their own characteristics. Extracellular volume (ECV) status of patients is a key point to differentiate SIADH and CSWS, and a comprehensive assessment of relevant ECV indicators may be useful in differentiating these two syndromes. Besides, instead of monitoring the urinary sodium excretion, more attention should be paid to the total mass balance, including Na+, K+, Cl−, and extracellular fluid. Furthermore, the dynamic detection of fractional excretions (FE) of urate before and after correction of HN and a short-term infusion of isotonic saline solution may be useful in identifying the etiology of HN. As for brain natriuretic peptide (BNP) or N-terminal prohormone of BNP (NT-proBNP), more prospective studies and strong evidence are needed to determine whether there is a pertinent and clear difference between SIADH and CSWS.

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Section: The Incidence and Clinical Characteristics Of Siadh And Cswsmentioning

confidence: 92%

Section: The Incidence and Clinical Characteristics Of Siadh And Cswsmentioning

confidence: 99%

Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Cui

Yang

et al. 2019

Front. Neurosci.

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“…Moreover, the patient complained of thirst. 3] ng/mL). The patient was diagnosed with CDI and panhypopituitarism and was treated with lthyroxine, hydrocortisone, and desmopressin, and replacement therapy was begun 5 days before surgery.…”

Section: Case Reportmentioning

confidence: 99%

“…Imbalance in fluid and electrolytes homeostasis is not rare in children after acute central nervous system (CNS) injury that particularly involves the pi tuitary gland 1) . Conditions, such as central diabetes insipidus (CDI), which can be transient or permanent and partial or complete, syndrome of inappro priate antidiuretic hormone secretion (SIADH), and cerebral salt wasting syndrome (CSWS) can occur in children with CNS injury 2,3) . CDI is associ ated with hypernatremia, whereas SIADH and CSWS are correlated to hypo natremia 4) .…”

Section: Introductionmentioning

confidence: 99%

Coexistence of Central Diabetes Insipidus and Prolonged Cerebral Salt Wasting Syndrome after Brain Tumor Surgery: A Case Report

et al. 2020

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Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after sur gery. Hyponatremia in a patient with CDI may be erroneously interpreted as ina de quate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.

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“…CSWS is defined as renal loss of Na during intracranial disorders leading to hyponatremia and a decrease in extracellular fluid volume. It is a rare and alarming condition, which is predominantly associated with subarachnoid hemorrhage, but can also occur after head injury, neurosurgery, intracranial neoplasm, or cerebral infection [ 4 , 8 ]. It was first described in 1950 as an explanation for the natriuresis and hyponatremia that sometimes is associated with cerebral disease [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

A challenging coexistence of central diabetes insipidus and cerebral salt wasting syndrome: a case report

et al. 2018

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BackgroundCombined central diabetes insipidus and cerebral salt wasting syndrome is a rare clinical finding. However, when this happens, mortality is high due to delayed diagnosis and/or inadequate treatment.Case presentationA 42-year-old white man was referred to neurosurgery due to a non-functional pituitary macroadenoma. He underwent a partial resection of the tumor on July 2, 2015. On the day following surgery he presented polyuria with sodium 149 mEq/L, plasma osmolality 301 mOsm/kg, and urine osmolality 293 mOsm/kg. He started nasal desmopressin 0.05 mg/day with good response. He was already on dexamethasone 4 mg and levothyroxine 75 mcg due to hypopituitarism after surgery. On July 9 he became confused. Cerebral computed tomography was performed with no significant changes. His natremia dropped to 128 mEq/L with development of polyuria despite maintenance of desmopressin dose. His hemoglobin and hematocrit rose from 9.1 g/L to 11.6 g/L and 27.5 to 32.5, respectively. His thyroid function was normal and he was on hydrocortisone 30 mg/day. At 12 p.m. 150 mg/hydrocortisone infusion was initiated, but sodium did not increase. Plasma and urine osmolality were 264 mOsm/kg and 679 mOsm/kg, respectively. At 4 p.m. hydrocortisone was increased and hypertonic saline replacement started. Two hours later he was dehydrated with polyuria and vomiting, and natremia of 124 mEq/L. Hyponatremia was very resistant to treatment despite hypertonic saline replacement, hence desmopressin was suspended. The following day, urine spot analysis showed that natriuresis was 63 mEq/L with serum sodium 132 mEq/L. This was interpreted as a cerebral salt wasting syndrome and control was achieved with aggressive hypertonic saline replacements and fludrocortisone 0.1 mg/three times a day. ConclusionsWe present a rare case of a patient with diabetes insipidus and cerebral salt wasting syndrome, who was successfully treated. Hyponatremia in a patient with diabetes insipidus may erroneously be interpreted as inadequate diabetes insipidus control or as syndrome of inappropriate antidiuretic hormone secretion, leading to therapeutic errors. Thus, all clinical and analytical data should be evaluated together for early and correct diagnosis.

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Sodium and Water Imbalance After Sellar, Suprasellar, and Parasellar Surgery

Cited by 23 publications

References 23 publications

Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Coexistence of Central Diabetes Insipidus and Prolonged Cerebral Salt Wasting Syndrome after Brain Tumor Surgery: A Case Report

A challenging coexistence of central diabetes insipidus and cerebral salt wasting syndrome: a case report

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