Delayed postoperative hyponatremia after endoscopic transsphenoidal surgery for pituitary adenoma
- 52 Downloads
Hyponatremia generally occurs after transsphenoidal surgery (TSS) in a delayed fashion. Most patients with delayed postoperative hyponatremia (DPH) are asymptomatic or only express non-specific symptoms; consequently, DPH is associated with prolonged hospitalization. No consensus has been reached on which patients are at greatest risk of developing DPH. We reviewed patients with DPH and evaluated predictive factors for DPH.
We retrospectively analyzed 107 consecutive patients who underwent endoscopic TSS for pituitary adenoma (January 2010–December 2016). Patients with DPH (hyponatremia group) and without DPH (normonatremia group) were compared according to their nadir sodium levels on postoperative days 3 to 10. We documented the patients’ demographics, clinical features, and postoperative physiological characteristics.
Twenty-five (23.4%) patients developed DPH after endoscopic TSS. The patients’ mean age was 54 ± 17 years, and 63.6% of the patients were female. The overall prevalence of DPH was 23.4%. The non-parametric χ2 test and the Mann–Whitney U test revealed statistically significant differences in age, use of antihypertensive drugs, nonfunctioning pituitary adenoma, and higher yet normal preoperative thyroid-stimulating hormone level between the hyponatremia and normonatremia groups (P < 0.05). Logistic regression analysis revealed that only older age was a useful independent predictive factor for DPH (odds ratio, 1.05; 95% confidence interval, 1.01–1.08; P = 0.01). The serum sodium levels on postoperative day 2 were significantly lower in the hyponatremia than normonatremia group (P < 0.01) and were negatively correlated with age (r = − 0.25, P < 0.05). The cut-off age for predicting DPH was 55 years. The hospital stay was significantly longer in the hyponatremia than normonatremia group (P < 0.01).
Age of more than 55 years was an independent predictive factor for DPH even after adjusting for potential confounders. Older age was negatively correlated with the serum sodium level on postoperative day 2. Preventing early decreases in the sodium level could reduce the risk of DPH.
KeywordsEndoscopic transsphenoidal surgery Hyponatremia Pituitary adenoma
We thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.
Compliance with ethical standards
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
- 4.Ayus JC, Arieff AI (1996) Abnormalities of water metabolism in the elderly. Semin Nephrol 16:277–288Google Scholar
- 6.Boehnert M, Hensen J, Henig A, Fahlbusch R, Gross P, Buchfelder M (1998) Severe hyponatremia after transsphenoidal surgery for pituitary adenomas. Kidney Int Suppl 64:S12–S14Google Scholar
- 29.Olson BR, Rubino D, Gumowski J, Oldfield EH (1995) Isolated hyponatremia after transsphenoidal pituitary surgery. J Clin Endocrinol Metab 80:85–91Google Scholar
- 32.Sane T, Rantakari K, Poranen A, Tahtela R, Valimaki M, Pelkonen R (1994) Hyponatremia after transsphenoidal surgery for pituitary tumors. J Clin Endocrinol Metab 79:1395–1398Google Scholar
- 38.Takeuchi K, Nagatani T, Okumura E, Wakabayashi T (2014) A novel method for managing water and electrolyte balance after transsphenoidal surgery: preliminary study of moderate water intake restriction. Nagoya J Med Sci 76:73–82Google Scholar
- 39.Tareen N, Martins D, Nagami G, Levine B, Norris KC (2005) Sodium disorders in the elderly. J Natl Med Assoc 97:217–224Google Scholar
- 42.Tomita Y, Kurozumi K, Terasaka T, Inagaki K, Otsuka F, Date I (2016) A case of an adrenocorticotropic hormone-producing pituitary adenoma removed via electromagnetic-guided neuroendoscopy. No Shinkei Geka 44:473–479Google Scholar