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01-06-2021 | Pituitary Adenoma | Original Article

Diabetes insipidus and syndrome of inappropriate antidiuresis (SIADH) after pituitary surgery: incidence and risk factors

Authors: Elena L. Sorba, Victor E. Staartjes, Stefanos Voglis, Lazar Tosic, Giovanna Brandi, Oliver Tschopp, Carlo Serra, Luca Regli

Published in: Neurosurgical Review | Issue 3/2021

Abstract

Electrolyte disorders are relatively frequent and potentially serious complications after pituitary surgery. Both DI (diabetes insipidus) and SIADH (syndrome of inappropriate antidiuresis) can complicate and prolong hospital and intensive care unit stay, and the latter may even be preventable. We aim to assess the incidence of both electrolyte disorders and their risk factors. From a prospective registry of patients who underwent endoscopic transnasal transsphenoidal surgery (TSS) for pituitary adenoma, patients with postoperative DI and SIADH were identified. Univariable and multivariable statistics were carried out to identify factors independently associated with the occurrence of either DI or SIADH. A total of 174 patients were included, of which 73 (42%) were female. Mean age was 54 years (range 20–88). During postoperative hospital stay, 13 (7.5%) patients presenting with DI and 11 (6.3%) with SIADH were identified. Patients who developed DI after surgery had significantly longer hospital stays (p = 0.022), as did those who developed SIADH (p = 0.002). Four (2.3%) patients were discharged with a diagnosis of persistent DI, and 2 (1.1%) with the diagnosis of SIADH. At the last follow-up, 5 (2.9%) patients presented with persistent DI, while none of the patients suffered from SIADH. Younger age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.01, p = 0.166) and pituitary apoplexy (OR 2.69, 95% CI 0.53–10.65, p = 0.184) were weakly associated with the occurrence of DI. We identified younger age (OR 0.96, 95% CI 0.92–0.99, p = 0.045) and lower preoperative serum sodium (OR 0.83, 95% CI 0.71–0.95, p = 0.008) as independent risk factors for SIADH. Although we found a weak association among age, pituitary apoplexy, and the occurrence of DI, no independent predictor was identified for DI. For postoperative SIADH however, lower age and preoperative serum sodium were identified as significant predictors. None of these findings were sufficiently supported by preexisting literature. Both electrolyte disorders are exquisitely hard to predict preoperatively, and further research into their early detection and prevention is warranted.

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Title: Diabetes insipidus and syndrome of inappropriate antidiuresis (SIADH) after pituitary surgery: incidence and risk factors
Authors: Elena L. Sorba
Victor E. Staartjes
Stefanos Voglis
Lazar Tosic
Giovanna Brandi
Oliver Tschopp
Carlo Serra
Luca Regli
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Pituitary Adenoma
Hyponatremia
Syndrome of Inappropriate ADH Secretion
Pituitary Apoplexy
Published in: Neurosurgical Review / Issue 3/2021
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-020-01340-0

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Diabetes insipidus and syndrome of inappropriate antidiuresis (SIADH) after pituitary surgery: incidence and risk factors

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