Water and Electrolyte Disorders at Long-Term Post-Treatment Follow-Up in Paediatric Patients with Suprasellar Tumours Include Unexpected Persistent Cerebral Salt-Wasting Syndrome

Abstract

Background: Patients with brain tumours have a high risk of water and electrolyte disorders (WED). Postsurgery diabetes insipidus (DI) may be transient or permanent, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) are usually transient. Methods: Retrospective study, including patients with suprasellar tumours, treated at Hôpital Necker, Institut Gustave-Roussy or Institut Curie, in Île-de-France, between 2007 and 2011. WED were noted if they persisted >1 month after surgery. Results: 159 patients were included, 54.1% girls, 43.9% boys. Tumour types were: glioma (43.4%), craniopharyngioma (43.4%), germinoma (11.3%), others (1.9%). Age at diagnosis was 7.1 ± 4.6 years. The median time from end of treatment was 1.9 (0-7.8) years. DI was the most frequent disorder after tumour treatment (50.3%) and was significantly associated with surgery (p < 0.001). Persistent CSWS was present in 3.6%, persistent SIADH in 1.3%. Two cases of hypernatraemia were due to adipsia. Thyrotropin deficiency after treatment was noted in 68.9% of patients tested, adrenocorticotropin deficiency in 66.2%. Conclusions: Patients with suprasellar tumours have a high incidence of long-term WED, mainly DI. Assessment of thyrotroph and corticotroph function, and thirst sensation, is necessary to diagnose and manage these disorders correctly. CSWS may be persistent in few patients and requires special attention to prescribe the appropriate care.

Adipsic Diabetes Insipidus: A Single-Center Case Series

“…This finding is in contrast to our speculations and previous reports, which suggest that damage to anterior and posterior hypophysis in craniopharyngioma management is more severe than in other surgical interventions causing ADI (1). Management of ADI is generally challenging, as the time of adipsia recovery is variable, and central DI persists despite adipsia recovery.…”

“…The occurrence of diabetes insipidus (DI) following neurosurgical procedures for brain tumors may be transient or permanent (1). Adipsia rarely accompanies DI (ADI) due to osmoreceptor destruction.…”

ICAR: endoscopic skull‐base surgery

“…disclosed that radical excision, recurrent tumor surgery, pituitary stalk injury, and transcranial approach are associated with higher incidence of postoperative DI, being in their series as high as 80%. They pointed out that fluid/electrolytes disorders, especially the so‐called “triphasic response” more commonly seen in children frequently leads to a differential diagnosis of DI vs SIADH . So, the immediate postoperative response of stalk/hypothalamus manipulation is temporary dysfunction with polyuria, followed by the antidiuretic phase due to the uncontrolled release of vasopressin from the posterior pituitary or the damaged hypothalamus; finally, another polyuric phase, when the ADH reserves are depleted.…”

Adipsic diabetes insipidus secondary to craniopharyngioma resection

“…Although DI is usually a common complication in patients with craniopharyngioma presenting in 61% of patients, adipsic DI represents a more infrequent complication, in the review made by the authors, 20 patients were found who presented this pathology secondary to craniopharyngioma 16–24. No associations were found in the literature with a particular type of histopathological pattern.…”